TREATISE 



ON 



EPIDEMIC CHOLERA; 



INCLUDING AN HISTORICAL ACCOUNT 



ITS ORIGIN AND PROGRESS, 



TO 



THE PRESENT PERIOD, 



COMPILED FROM THE MOST AUTHENTIC SOURCES. 



> 



BY A. BRIGHAM, M. D. 



HARTFORD: 

PUBLISHED BY H. AND F. J. HUNTINGTON. 

1832. 



TREATISE 

ON 

EPIDEMIC CHOLERA: 

INCLUDING AN HISTORICAL ACCOUNT 

OF 

ITS ORIGIN AND PROGRESS, 

TO 

THE PRESENT PERIOD, 

COMPILED FROM THE MOST AUTHENTIC SOURCES. 



BY A. BRIGHAM, M. D. 



HARTFORD: 

PUBLISHED BY H. AND F. J. HUNTINGTON, 

1832. 



m 



ADVERTISEMENT. 

The following work has been chiefly selected from nu- 
merous but authentic Reports, Treatises, Lectures and Essays 
upon the cholera, which has prevailed epidemically for the 
last 15 years. It is intended to furnish a correct history 
of the disease, together with all the most important prac- 
tical information that has been published respecting its na- 
ture, causes and methods of treatment. 

For this purpose the writings of those practical medical 
men, who have witnessed the disease in Asia, on the con- 
tinent of Europe, in England, the Canadas, and the United 
States, have been resorted to in making this selection. 

The history of the cholera anterior to 1817, has been 
chiefly derived from the Report of the Madras Medical 
Board, drawn up by order of the government, in 1824. 
The subsequent history of the disease, or from 1817 to 1831, 
was written by H. O. Lombard, M. D., and was originally 
published in French, in the Biliotheque Universelle for 1831, 
from which I have translated it. 

The other sources from which the principal part of the 

volume has been derived, are indicated at the proper places 

in the body of the work. They are principally the official 

reports made by medical men to the governments of the 

different countries where the disease has prevailed, the 

valuable medical periodical journals, for several years past, 

particularly The Medico Chirurgical Transactions, The 
1* 



^ 



IV ADVERTISEMENT. 

Edinburgh Medical and Surgical Journal ; The Medico 
Chirurgical Review ; The American Journal of Medical 
Sciences ; the Treatises, Essays, Lectures and Letters of 
different medical men in various parts of the world, who 
have had great experience in the disease. 

A. B. 
Hartford, August 20th, 183*2. 



CONTENTS. 



History of the cholera previous to 1817, Page 13 

History of the cholera from 1817 to 1832 . 26 

Progress of the cholera in 1817, . . . 28 

" 1818, ... 31 

" 1819, ... 33 

" 1820, ... 37 

" 1821, ... 39 

" 1822, ... 42 

" 1823, ... 43 

" 1824, ... 46 

" 1825, ... 47 

" 1826, ... 48 

" 1827, ... 49 

" 1828, ... 50 

" 1829, ... 51 

" 1830, ... 53 

" 1831, ... 54 

" 1832, ... 57 

History of the symptoms of cholera, ... 59 

Symptoms of the cholera in Asia, . n . 60 

Europe, ... 76 

" " America, . . . 101 

Appearances on dissection, . . . . ] 05 

Appearances on dissection in Asia, . . .106 

Mauritius, . . 114 

Europe, . . 117 

Treatment of the cholera, . . . . 135 

Treatment of the cholera in Asia, . . . 142 

" " Mauritius, . . 162 

" " Europe, . . 166 

England, . . 181 

" " " Canada and U. States, 230 

Two Lectures on the cholera at Paris, by Broussais, 250 

1## 



6 CONTENTS. 

Causes of the cholera, 295 

Evidence that the cholera is contagious, . . 296 
Objections to the evidence that the cholera is con- 
tagious, . . 298 

Evidence of the non-contagious nature of the 

cholera, 821 

Evidence that the influenza is as contagious as the 

cholera, 829 

Means of prevention of the cholera, . . .831 
Is the present epidemic cholera a different disease 

from the common cholera morbus ? . . 839 
Has a similar epidemic prevailed before in this 

country? . . . . . . 841 

Influence of fear in producing and aggravating the 

epidemic cholera, . . . . .. 345 



APPENDIX. 

Recent progress of the cholera in Europe, . . 355 
Canada and U. States, 363 



INTRODUCTION. 

The pestilence which is now raging in various parts of 
the United States, and which during the last fifteen years 
has advanced over a large portion of the globe, is now 
the most absorbing topic throughout the civilized world. 
By many it is considered a new disease, while others say 
it was known in the earliest ages. Whether the latter 
is true or not, we have no account of its ever having 
prevailed extensively and epidemically, and for years in 
succession previous to 1817. We do not know, how- 
ever, but some of the destructive diseases which swept 
off vast numbers of the human race in remote times were 
of the same nature. Our accounts of them are so imper- 
fect that we are unable to determine their nature. The 
learned M. Montbroin, conceives that a similar disease des- 
troyed 70,000 of the subjects of King David from Dan 
even to Beersheba. (II. Sam. xxiv.) Josephus' account of 
this pestilence is as follows : " The terrible malady seized 
them before they were aware and brought them to their 
end suddenly, some giving up the ghost immediately, with 
very great pains, and bitter grief, and some were worn 
away by their distempers, and had nothing remained to be 
buried, but as soon as ever they fell, were entirely mace- 
rated ; some were choked, and greatly lamented their case, 
as being also stricken with a sudden darkness ; some there 
were who as they were burying a relative, fell down dead, 
without finishing the rites of funeral. There perished of 
this disease, which began with the morning, and lasted till 
the hour of dinner, 70,000." 

Several other mortal pestilences are alluded to by those 
who have written concerning the diseases of ancient times. 



8 INTRODUCTION. 

Dr. Webster in his work on Epidemic and Pestilential Dis- 
eases,* mentions several that prevailed in this country about 
the time of the first settlement by the English. 

A pestilential and mortal disease prevailed among the 
Indians in 1618, and to such an extent as to greatly dimin- 
ish their numbers. When our ancestors arrived two years 
after, they found the bones of those who perished, in many 
place unhurried. But the accounts we have of these early 
epidemics are so imperfect that we are unable to determine 
the nature of the malady. 

In the third year of the 87th Olympiad, answering to the 
430th preceding the Christian era, a plague broke out in 
the city of Athens, which was far more mortal than any 
which before that time had been known to the Greeks. In 
a short time it destroyed an immense multitude of the poor, 
and five thousands of the flower of the Athenian armies. 
It broke out in the second year of the Peloponnesian war, 
when all the inhabitants of the Athenian territory were 
crowded into the city to avoid the destructive ravages of 
the Lacedemonians. 

The population of Athens was thus increased from 50,000 
to 400,000. " The city," says Thucydides, " was not 
able to receive so large a conflux of people, many w T ere 
forced to lodge in the turrets of the walls," &c. The 
enemies of Pericles, says Plutarch, " attributed the oc- 
currence and the great ravages of the pestilence to the 
multitude of people he had collected into the city in the 
heat of summer." And this was probably the true cause. 
The exact nature of the disease we do not know, though 
the symptoms of the disease are described by Thucydides ; 
yet he makes no mention of the swellings of the glands 
which usually occur in the plague. Dr. Webster thinks 

* We are gratified to learn that the venerable author of this va- 
luable and philosophical work is about publishing a new edition, with 
additions, and a continuation to the present time. 



INTRODUCTION. 9 

the disease resembled the worst forms of yellow fever. 
The disease like the cholera first appeared in that part of 
the city where there was the least cleanliness and among 
the ill conditioned poor, here it " fell suddenly" and thence 
gradually extended to other parts of the city. For a full 
and philosophical account of this plague at Athens, see the 
first article, in the first volume of the Medical Repository, 
by the late Dr, E. H. Smith of New York. 

During the reign of Justinian I. A. D. 542, a universal 
and destructive plague prevailed to such an extent as to 
dispeople some of the fairest portions of the world. " This 
pestilence," says Procopuis, " which almost destroyed the 
human race and for which no cause can be assigned but the 
will of God, ravaged the whole world, without regard to 
age, sex or condition and prevailed during the winter and 
summer and all seasons of the year." It seized Constan- 
tinople in the spring of 543 and according to Gibbon, " dur- 
ing three months, five, and at length ten thousand persons 
died each day at Constantinople ; many cities of the East 
were left vacant and in several districts of Italy the harvest 
and the vintage withered on the ground." 

Those attacked by the disease were affected by swellings 
and carbuncles and the characteristic symptoms of the 
plague. 

In 1345 the most general and destructive pestilence com- 
menced that the world has ever known. This disease like 
the cholera made its first appearance in the East. It com- 
menced in Cathay, China, in 1345, and was so deadly that 
at least one half or two thirds of the human race perished in 
8 years. It did not entirely disappear until after about 20 
years ? and after having overrun the world. 

This awful pestilence was preceded by great and gene- 
ral disorder of the elements such as had never before been 
known. The mortality fell chiefly upon the lower classes 



10 INTRODUCTION. 

of society ; not one king or prince of any nation died of the 
disease, and the English nobility and people of distinction 
and the higher orders of the church generally escaped. 

Before the disease invaded Christendom, according to a 
report made to the Pope, it had swept away twenty three 
millions eight hundred thousand persons in the East in the 
course of a single year. At length it passed into Italy ; and 
at Florence 60,000 persons died in one year. The malady 
proceeded north to Germany and France. At Paris it cut 
off 50,000 persons ; and at Lubeck according to several 
accounts it swept away 90,000 persons in one year, of 
whom 1,500 died in the space of four hours. 

It reached England in 1348, where it raged to an extent 
almost incredible. According to the historians of that 
time, out of the whole population, hardly one person in ten 
was left alive. In the city of Norwich 57,374 persons died 
in six months, and at York and London it was horrible be- 
yond imagination. In London 50,000 persons were burried 
in one grave yard. Such was the consternation through- 
out England that the cattle were neglected and run at large, 
the corn perished for want of reapers and whole villages 
were depopulated. 

This disease has been compared to the cholera, but the 
symptoms were somewhat different. It was usually ac- 
companied by violent affection of the head and stomach, 
glandular swellings, blisters over the body and hemorrhages 
from the mouth and nose. (For a full account of this great 
plague in the 14th century, see Fraser's Magazine, for 
May 1832.) 

The last pestilence which I shall notice, is the Great 
Plague of London which prevailed in 1665, and the memo- 
ry of which has been rendered immortal by eloquent des- 
criptions in prose and poetry. It first attracted attention 
in London about the middle of summer, and was preceded 
and accompanied by a peculiar state of the atmosphere. 



INTRODUCTION. 11 

Its ravages soon augmented, and in the autumn 8,000 per- 
sons died in one week, though two thirds of the inhabitants 
had fled the city. From this time it grew milder, and by 
the spring, had totally vanished. According to the bills of 
mortality, London lost upwards of 68,000 inhabitants by 
the plague, in 1665. This was the last plague that appear- 
ed in Great Britain. 

These are but a small number of the visitations of pesti- 
lence which the generations of men have experienced. 
They have all been, to be sure, most afflicting events, not 
only from the destruction of human life which they pro- 
duce, but from the pain and suffering which those who sur- 
vive must endure, and the destitution of innumerable widows 
and orphans, and helpless beings. But though exceedingly 
distressing calamities for a time, yet history shows that ul- 
timately they may not prove injurious to the welfare of 
mankind in general. Though many valuable members of 
society are cut off at such times, yet in general the greatest 
lavages are among those least necessary to the welfare of 
society. They have most frequently occurred in thickly 
populated places, in countries overflowing with inhabitants, 
like Hindostan and China, where the common necessaries 
of life, even in productive seasons, are furnished only in 
sufficient quantity to barely allow a miserable existence to 
the great mass of population, and when a failure of crops 
occurs, multitudes die from famine. The writings of Mal- 
thus and Say, and the tables of Sussmilch, and others, shew 
that in many countries, after the plague had swept off a 
third of the population, the annual number of births be- 
came greater than before the pestilence. 

In all countries, innumerable beings die of want, not 
that they actually starve for want of food, but for want of 
the care of parents or nurses, or medical advice, or rest, 
which many in all countries are unable to have. In gene- 
ral, pestilential and mortal epidemics have apparently been 



12 INTRODUCTION. 

caused by a want of some of the necessaries of life, among 
the people, — very frequently, by famine, or want of food. 
But not always a want of food, but a want of pure air, 
cleanliness, warm clothing and lodging, or rest, or medical, 
and other attention, which none but those who are supplied 
with other products necessary for man can obtain. They 
therefore must occur whenever the population is not sup- 
plied with the necessaries of life. 

Hence we see all such general calamities are most fatal 
in cities and populous places. In the Hebrew scriptures, 
the prophets Jeremiah and Ezekiel often speak of the pesti- 
lence sent in judgement upon men, but it is curious to notice 
that it is the peculiar scourge of cities. The siege of Je- 
rusalem is thus foretold, — 1 1 will smite the inhabitants of this 
city, they shall die with a great pestilence. He that abi- 
deth in the city shall die, but he that goeth out and falleth 
to the Chaldeans that besiege you, he shall live. 9 Jer. xxi. 
Ezek. chap. v. declares thus, — c those in the field shall 
die by the sword, and he that is in the city, by famine and 
pestilence ;' and again, chap, xxxiii. < they that are in the 
wastes shall fall by the sword, and him that is in the open 
field, will I give to the beasts to be devoured, and they that 
be in the forts and caves shall die by pestilence.' 

But such a calamity may, in other ways, prove beneficial 
to succeeding generations. It teaches, or should teach, 
mankind how to live ; to be frugal, to provide beforehand 
for sickness, to be temperate in all things ; to avoid and 
prevent accumulations of filth, and impure air, and crowded 
rooms and cities. 

Take for instance the present epidemic, and though no 
language can describe the suffering, the agony, and the 
innumerable evils that it brings upon mankind ; yet will it 
pass away without inculcating any important truth ? will it 
teach no profitable lesson to the present and succeeding gene- 
rations ? 

Considering the enquiring and investigating age in which 



INTRODUCTION. 13 

this calamity has appeared, we can hardly believe but that 
some of the causes which has produced or aggravated this 
pestilence will be ascertained, and may hereafter be avoid- 
ed, and thus succeeding generations profit by the sad expe- 
rience of this. 

It can hardly fail to prove one of the greatest reformers 
the world has ever known. It can not fail to teach man- 
kind temperance, frugality and innumerable other virtues. 
It will apprise men of the danger of small ill ventilated and 
crowed houses, streets and cities. It will guide them in 
constructing and locating dwellings — and large towns ; and 
it may teach men to forsake cities, and the strife for gain, 
and seek quiet and competence in the pure air of the coun- 
try. This is no unimportant lesson for man to learn. And 
but few more necessary for the moral advancement of man- 
kind. Large cities, are the chief hot-beds and nurseries of 
vice. They congregate within their walls a large and 
combined mass of ignorant, vicious, evil disposed beings, 
that benevolence does not and cannot rescue, and which 
thwart all the efforts of the philanthropic ; and serve as 
schools of vice and dissipation for rising generations. They 
also by their prodigality, imprudence and sensuality, conta- 
minate the atmosphere and produce disease and aggravate 
pestilence. 

While therefore every measure should be adopted likely 
to arrest the present general and distressing calamity, let 
us not forget to profit by it when it has past ; and by keep- 
ing steadily and constantly in mind the causes that have 
now produced or greatly aggravated the disease, endeavor 
to prevent its recurrence by our conduct hereafter. 



EPIDEMIC CHOLERA MORBUS. 

HISTORY OF THE EPIDEMIC CHOLERA, 
PREVIOUS TO 1817. 

When the Epidemic Cholera Morbus appeared at 
Jessore, in 1817, it was supposed to be a new disease; 
but upon enquiry, it was ascertained that a com- 
plaint similar in all its symptoms, had not only been 
described in several publications on the diseases of 
India, but had been noticed in the earliest records of 
medicine. Hippocrates speaks of it, and it is de- 
scribed by Aritjss, of Cappadocia. 

Bontius, a Dutch physician residing at Batavia, 
and who wrote in 1629, thus accurately describes it. 

" Besides the diseases above treated of as endemic 
in this country, the cholera morbus is extremely fre- 
quent ; in the cholera, hot, bilious matter, irritating 
the stomach and intestines, is incessantly, and copi- 
ously discharged by the mouth and anus. It is a dis- 
order of the most acute kind, and therefore requires 
immediate application. The principal cause of it, 
next to a hot and moist disposition of the air, is an 
intemperate indulgence of eating fruits, which, as 
they are generally green, and obnoxious to putrefac- 
tion, irritate and oppress the stomach by their super- 
fluous humidity, and produce an eeruginous bile. 
The cholera might, with some degree of reason, be 
reckoned a salutary excretion ; since such humors 

2 



14 EPIDEMIC CHOLERA 

are discharged in it, as, if retained, would prove pre- 
judicial. However, as by such successive purgations., 
the animal spirits are exhausted, and the heart, the 
fountain of heat and life, is overwhelmed with putrid 
effluvia, those who are seized with this disorder general- 
ly die, and that so quickly, as in the space of four and 
twenty hours, at most. 

Such, among others, was the fate of Cornelius Van 
Royen, steward of the Hospital of the sick, who be- 
ing in perfect health at six in the evening, was sud- 
denly seized with the cholera, and expired in terrible 
agony and convulsions before twelve o'clock at night ; 
the violence and rapidity of the disorder surmounting 
the force of every remedy. But if the patient should 
survive the period above-mentioned, there is great 
hope of performing a cure. 

This disease is attended with a weak pulse, difficult 
respiration, and coldness of the extreme parts ; to which 
are joined, great internal heat, insatiable thirst, per- 
petual watching, and restless and incessant tossing of 
the body. If together ivith these symptoms*, a cold and 
fetid sweat should break forth, it is certain that death 
is at hand." 

Sydenham, and other writers*, notice its prevalence 
in London, in 1669 — 1676, and in 1741. It is said 
to have prevailed in several parts of Europe, from 
1600 to 1780. At Paris extensively in the summers 
of 1730, 1750, and again in 1780, and in Switzerland 
in 1696. 

Anterior to the present age, the epidemic or pesti- 
lential form of Cholera, had, however, rarely appear- 
ed in Europe. It had occurred more frequently in 
India, and its ravages there had been greater. 

* Huxham, Dr. Brady, &c. 



PREVIOUS TO 1817. 15 

Lebegue de Presle says it prevailed in Uppe 
Hindostan in 1762, where it destroyed 30,000blacks, 
and 800 Europeans. 

Dr. Paisley, in a letter dated at Madras, 12th Feb- 
ruary, 1 774, and published by Curtis, in his work on 
diseases of India, says that the cholera is often epi- 
demic there, and destroys quickly great numbers of 
the Blacks, though it prevails among both Europeans 
and natives, He observes, " it is totally a disease of 
highly putrid bile, which operates on the system as 
poison, and brings on sudden prostration of strength, 
and spasms over the whole surface of the body." 

M. Sonnerat, in his travels in India from 1774 to 
1781, says that cholera prevailed epidemically on 
the Coromandel coast, and at one period assumed a 
very malignant character, destroying above sixty 
thousand people, from Cherigam to Pondicherry. The 
following is his account of it. 

" There is also another epidemical disorder, which 
reigns, and in twenty-four hours, or sometimes less, 
carries off those who are attacked. It never appears 
~ but in cold weather.' 5 

" Debauchees, and those who have indigestions, 
are attacked with a looseness, or rather with an in- 
voluntary flux of the excrementary matter become 
liquid, but without any mixture of blood. They 
have no remedy for this current of the bowels,* which 
they call a sharp flux, but leave the cure to the care 
of nature. 1 " 

" The flux of this kind which reigned some years 
ago, spread itself in all parts, making great ravages : 
above sixty thousand people, from Cherigam to Pon- 

* Probably " cours de ventre," in the original. The edition here 
quoted, is a translation by Francis Nagnus, Calcutta, printed 1773* 



16 EPIDEMIC CHOLERA 

dicherry, perished. Many causes produced it. Some 
were attacked for having passed the night and slept 
in the open air ; others for having eat cold rice and 
curds ; but the greater part for having eat after they 
had bathed and washed in cold water, which caused 
an indigestion, an universal spasm of the nervous 
kind, followed by violent pains and death, if the pa- 
tient was not speedily relieved. This epidemical 
disorder happened during the Northerly winds in De- 
cember, January, and February ; when they ceased 
the malady disappeared. The symptoms of this dis- 
order were a watery flux, accompanied with vomit- 
ing and extreme faintness, a burning thirst, an op- 
pression of the breast, and a suppression of urine. 
Sometimes the deceased felt violent cholicky pains ; 
often lost his speech and recollection, or became deaf, 
the pulse was small and concentered, and the only spe- 
cific which Choisel, a foreign Missionary, found, was 
treacle and Drogue amere. The Indian physicians 
could not save a single person." 

" There is great reason to imagine that the perspi- 
ration being stopped and reflowing into the mass of 
blood, by finding its way to the stomach and bowels, 
occasion the vomiting, which termitated by this flux." 

" That which followed, two years after, was the 
most dreadful. It did not proceed from the same 
cause as the first, as it began in July and August: 
it first showed itself by a watery flux, which came 
in an instant, and sometimes cut the deceased off in 
less than four and twenty hours. Those who were 
attacked had thirty evacuations in five or six hours ; 
which reduced them to such a state of weakness that 
they could neither speak nor move. They were often 
without pulse ; the hands and ears were cold ; the face 



PREVIOUS TO 1817. 17 

lengthened ; the sinking of the cavity of the socket of 
the eye was the sign of death ; they felt neither pains 
in the stomach, cholics, nor gripings. The greatest 
pain was a burning thirst. Some brought forth worms 
by stool ; others by vomiting. This cruel pestilence 
affected all the castesin general, but particularly those 
who eat meat, as the Parias. The native Physi- 
cians succeeded no better in their treatment of this 
disorder, which was again renewed during the north 
winds." 

The epidemic cholera morbus, prevailed at the 
island of Mauritius in 1819 and 1820, and from en- 
quiries then made by a Committee of British Medical 
Officers, it was ascertained that a similar disease 
prevailed there in 1775, and which continued about 
two months, causing great mortality, particularly 
among the blacks and people of color. A hurricane 
was supposed to have put a stop to its ravages. 

The disease raged with great violence in India, in 
1781. Mr. Jameson, Secretary to the Calcutta Med- 
ical Board, thus alludes to it : 

"A division of Bengal Troops, consisting of about 
5,000 men, was proceeding under the command of 
Colonel Pearse of the Artillery, in the Spring of 1781, 
to join Sir Eyre Coote's Army on the Coast. It 
would appear that a disease resembling cholera 
had been prevalent in that part of the country, (the 
Northern Circars,) some time before their arrival ; 
$nd that they got it at Ganjam on the 22d March. 
It assailed them with almost inconceivable fury. 
Men previously in perfect health dropt down by do- 
zens ; and those even less severely affected were gen- 
erally dead or past recovery within less than an 
hour. The spasms of the extremities and trunk 



18 EPIDEMIC CHOLERA 

were dreadful; and distressing vomiting and purging 
were present in all. Besides those who died, above 
five hundred were admitted into hospital on that day. 
On the two following days, the disease continued un- 
abated, and more than one half of the Army was 
now ill." 

" The disease to which we allude, has not been 
confined to the country near Ganjam. It afterwards 
found its way to this place (Calcutta) ; and after 
chiefly affecting the native inhabitants, so as to oc- 
casion a great mortality during the period of a fort- 
night, it is now generally abated, and pursuing its 
course to the northward." 

The disease was referred to the great fatigue of the 
soldiers, after marching for several days and nights, 
through sand and salt water, exposed to heavy dews 
and a damp and variable atmosphere. 

Curtis, in his work on the diseases of India, speaks 
of the unusual prevalence of cholera in 1782. 

He says " that the fleet in which he served, joined 
Sir Edward Hughes's squadron at Madras, in the 
beginning of 1 782 ; in May of that year, his ship, the 
Seahorse, arrived at Trincomalee, and he says, ' The 
mart de chien, or cramp, I was also informed by the 
attending Surgeon, had been very frequent and fatal 
among the seamen, both at the hospital and in some 
of the ships, particularly in the Hero and Superb/ 
The Seahorse had no case of the disease till the 21st 
of June, when between that day and the 25th they 
had eight cases. 

" In every one of the eight cases the symptoms were 
so much alike, both in order and degree, that a de- 
scription of any one would answer almost equally 
well for every other. Any difference that took place 



PREVIOUS TO 1817. 19 

was in the suddenness of the attack, or the rapidity 
with which the symptoms succeeded each other. In 
all of them the disease began with a watery purging, 
attended with some tenesmus, but with little or no 
griping. This always came on some time in the 
night, or early towards morning, and continued some 
hours before any spasms were felt ; and light affec- 
tions of this kind being very common in the country, 
the patients seldom mentioned them till they began to 
be more severe^ and extended to the legs or thighs. 
This purging soon brought on great weakness, cold- 
ness of the extremities, and a remarkable paleness, 
sinking and lividity of the whole countenance. Some 
at this period had some nausea, and retching to 
vomit, but brought up nothing bilious. In a short 
time the spasms began to affect the muscles of the 
thighs, abdomen, and thorax, and lastly they passed 
to those of the arms, hands and fingers ; but I never 
saw, then or afterwards, those of the neck, face or 
back at all affected. The rapidity with which these 
spasms succeeded the first attack, and their severity, 
especially as affecting the muscles of the thorax and 
abdomen, denoted in general the degree of danger in 
the case* The affection is not, as in tetanus, confi- 
ned to a single muscle, or to a certain class of muscles 
only. Neither does it, as in the spasmus clonicus, 
move and agitate the members. It is a fixed cramp 
in the belly of the muscles, which is gathered up into 
a hard knot, with excruciating pain. In a minute or 
two this relaxes, is again renewed, or the affection 
passes to others, leaving the miserable sufferer hard- 
ly an interval of ease ; and lastly, it passes from one 
set to another; from those of the inferior extremity to 
those on the upper parts, leaving the former free. 



£0 EPIDEMIC CHOLERA 

The patients complain much of the pain of these 
cramps ; think they obtain some relief by friction of 
the parts, and cry to their companions to rub them 
hard. As the disease proceeded, the countenance 
became more and more pale, wan, and dejected ; the 
eyes became sunk, hollow, and surrounded w 7 ith a 
livid circle. The pulse became more feeble, and 
sometimes sunk so much as not to be felt at the wrist, 
in two or three hours after the spasms came on. But 
so long as it could be felt, it was but little altered in 
frequency. If the spasms happened to intermit, it 
would sometimes rise a little, and the countenance 
assume a better look. The tongue was generally 
white, and more or less furred towards the root; the 
patients had all great thirst, or rather a strong desire 
for cold drinks ; but there was no head ache or affec- 
tion of the sensorium commune throughout." 

" The coldness of the extremities, which was per- 
ceptible from the very first, continued to increase, and 
spread over the whole body? but with no moisture in 
the skin till the severity of the pain and spasms forced 
out a clammy sweat, which soon became profuse. 
The hands now began to put on a striking and peculiar 
appearance. The nails of the fingers became livid, 
and bent inwards ; the skin of the palms became 
white, bleached, and wrinkled up into folds, as if long 
soaked in cold water ; the effect, no doubt, of the pro- 
fuse cold sweat, which is one of the most pernicious 
and fatal symptoms of the disease, both from the effect 
it has in such a climate, of exhausting the strength, 
and in abstracting heat from the system. In some of 
the present cases, and in many others after this, we 
had recoveries from the severest degrees of spasmodic 
affection ; even where the pulse had been for hours 



PREVIOUS TO 1817. 2l 

completely lost at the wrist, and the body perfectly 
cold ; but never of any who had these profuse cold 
clammy sweats, and where the hands had put ont his 
appearance," 

' " All this while the purging continued frequent, and 
exhibited nothing but a thin watery matter or mucus. 
In many, the stomach became at last so irritable, that 
nothing could be got to rest upon it ; but every thing 
that was drank was spouted out immediately ; with- 
out straining or retching. The countenance and ex- 
tremities became livid, the pulsations of the heart 
more quick, frequent, and feeble ; the breathing be- 
gan to become laborious and panting ; and, in fine y 
the whole powers of life fell under such a great and 
speedy collapse, as to be soon beyond the power of 
recovery. In this progression, the patient remained 
from three to five or six hours from the accession of 
the spasms ; seldom longer. These began at last to 
abate, but with more internal oppression, great jac- 
titation, panting and gasping for breath, from the di- 
minished action of the respiratory organs ; for there 
were no marks of oppression or effusion on the lungs ; 
and the motion of the heart, so long as it could be 
felt, became more and more quick and irregular, till 
death came at last to the relief of the miserable suf- 
ferer. Sometime before that event took place, the 
spasms gradually abating, left the sufferers entirely, 
and so much possession of their faculties did they 
retain, that they would continue to talk sensibly to 
their messmates, to the last moment of their life, even 
when the whole body had become perfectly cold, and 
all pulsation of the heart had ceased for a long time 
to be distinguishable." 

"About the middle of July, 1782, 1 entered on du- 



22 EPIDEMIC CHOLERA 

ty at Madras Hospital. Here again, 1 had occasion 
to see many more cases of the mort de chien. It was 
frequent in the fleet in the month of August, and be- 
ginning of September, the season at which the land 
wind prevails on this part of the coast. We had 
some cases in the hospital in the end of October, and 
November after the monsoon, but few in compari- 
son." 

Girdleston, also, alludes to the ravages of the same 
epidemic, among the newly arrived troops from Eng- 
land, in his Essay on the Spasmodic affections of In- 
dia. 

He observes, " Spasms were the first disease which 
appeared amongst the troops w T ho arrived at Madras 
in October, 1782, under the command of Major Gen- 
eral Sir John Burgoyne. More than fifty of these 
fresh men were killed by them within the first three 
days after they were landed in that country, and in 
less than a month from that time, upwards of a thou- 
sand had suffered from attacks of this complaint." 

" The symptoms which commonly first presented 
themselves were coldness of the surface of the body, 
especially of the hands, feebleness of the pulse, and 
.spasmodic contractions of the lower extremities, soon 
extending to the muscles of the abdomen, diaphragm, 
and ribs. As the spasms advanced, the muscles 
might be seen to assume the rigidity of cartilages ; 
sometimes causing the body to remain immovea- 
bly extended, sometimes bending the trunk through 
its whole length, anteriorly ; and sometimes, though 
seldomer, backwards. The parts in which the 
spasms began generally remained rigid ; but those 
which were subsequently seized with them, had mo- 
mentary intermissions of the contractions 5 the only 



PREVIOUS TO 1817. 23 

intervals of relief experienced by the patient from the 
most tormenting pains. The hands and feet then 
generally became sodden, with cold sweat, the nails 
livid, the pulse more feeble and frequent, and the 
breath so condensed as to be both seen and felt, issu- 
ing in a cold stream at a considerable distance. The 
thirst was insatiable, the tongue whitish, but never 
dry ; vomitings became almost incessant ; the spasms? 
cold sweats, and thirst, increased with the vomitings ; 
which last, if not checked, soon terminated the exist- 
ence of the patient/ 5 " In this manner, most com- 
monly, was the succession of phenomena ; but often 
they were so rapid in their attack, that they seemed 
to seize the patient all in conjunction instantaneous- 
ly." 

" In some few, the extremities remained warm ; 
in others also the spasms were only clonic or convul- 
sive. Some died in the first hour of the attack ; oth- 
ers lived a day or two with remissions; when they 
died, either of universal spasms or an apoplexy. On 
dissection of the bodies after death, it appeared that 
no injury had been sustained by the brain, liver, gall- 
bladder, stomach or heart. The prognosis of this dis- 
ease is formed with greater certainty from the warmth 
or coldness of the extremities, than from either the 
universality of the spasms, or the frequency or steadi- 
ness of the pulse. Thus if the spasms were ever so 
general, with warmth of the extremities, there was no 
immediate danger ; on the contrary if the spasms were 
ever so trifling, with coldness, there was every danger 
to be feared." 

It is also stated in the Bengal Report, that the cho- 
lera appeared at Hurdwar on the Ganges, in April, 
1783. Its prevalence at this place is very deserving 
of attention. 



24 EPIDEMIC CHOLERA 

Hurdwar on the Ganges, is a place held particu- 
larly sacred by the Hindoos. At this time an im- 
mense multitude had assembled on occasion of a re- 
ligious festival. 

It was computed that from one to two millions of 
people had assembled here on the banks of the holy 
Ganges, where they passed several days and nights, 
crowded together, and exposed to a burning sun by 
day, and to heavy dews and cold blasts from the 
mountains at night. 

The cholera suddenly appeared among this crowd 
of devotees, and was undoubtedly generated among 
them, and raged with such violence as to destroy 
above 20,000 people in the short space of eight days. 
But it is a remarkable fact that this disease did not 
spread from this point, not even to the villages within 
a few miles, and ceased immediately on the disper- 
sion of the multitude who had assembled at Hurd- 
war. 

In 1787 the cholera prevailed at Vellore, Arcot, 
and Trincomallee, and has been described by Dr. 
Duffin, Dr. Davis, and Mr. Thompson. At these 
places it raged with great violence, and so rapid in 
its progress, that many were carried off in twelve 
hours. It prevailed here most in October and No- 
vember. Nausea, frequent heats and chills, cold 
sweats, severe gripings and purgings, retchings to vo- 
mit, intense thirst, with spasms and a sinking of the 
pulse, were the characteristic symptoms of the disease 
at these places. 

In 1 790, the cholera was again very prevalent, says 
the Calcutta report, and very destructive in a detach- 
ment of Bengal troops marching through the North* 



PREVIOUS TO 1817. 25 

ern Circars, in the months of March, April, May and 
June of 1790. The disorder was characterized by 
precisely the same symptoms which mark the present 
epidemic. u It began with violent pain and spasm 
in the stomach and bowels, which were followed by 
purging, vomiting, and all the signs of extreme debili- 
ty." In one division consisting of 1000 artillerists, 
the cholera appeared, and destroyed 700 of them in 
six days. 

Dr. James Johnson, in his work on the diseases of 
tropical climates, alludes to the prevalence of this dis- 
ease in the vicinity of Trincomallee, about the year 
1804, and refers to Curtis's description of the same 
disease. The following is one of the cases he gives 
of the complaint. 

" A seaman on waking after a debauch, repaired to 
the deck, and there again he fell asleep, during the 
chilly part of the night. c About 4 o'clock in the 
morning he awoke with a shiver and left the deck, 
but was soon seized wdth frequent purging and gri- 
ping, his stools consisting of mucus and slime. Nau- 
sea and retching succeeded ; nothing being ejected 
but phlegm, and the contents of the stomach. His 
pulse was small, quick, and contracted ; his skin dry, 
but not hot. About eight o'clock in the morning he 
began to feel spasms in different parts of his body, 
which soon attacked the abdominal muscles, and 
threw him into great pain. During these paroxysms, 
a cold clammy sweat would be occasionally forced 
out, especially in the face and breast. The extre- 
mities now became cold ; his features shrunk ; the 
stomach rejecting every thing which was offered either 
as medicine or drink. The abdomen and epigastrium 



26 HISTORY OF THE CHOLERA 

all this time were distended and tense, with incessant 
watery purging and painful tenesmus. By ten o'clock 
his pulse could scarcely be felt ; his breathing was 
oppressed and laborious, his eyes sunk, and the whole 
countenance singularly expressive of internal agony 
and distress. The extremities were cold, shrivelled, 
and covered with clammy sweats. The violence of 
the spasms now began to relax ; and by eleven o'clock, 
or seven hours from the attack, death released him 
from his sufferings.' This may serve as a specimen 
of the worst form of that dreadful disease, which has 
obtained the appellation of c mort de chien,' or the 
'death of a dog.'" 

Several other w T riters allude to the prevalence of 
this disease in India previous to 1817, and although 
its ravages have not been so great as subsequent to 
that period, yet no doubt can exist in the mind of any 
one who examines the subject, of the fact that chole- 
ra has very frequently prevailed epidemically in In- 
dia, previous to its appearance at Jessore. But as it 
did not attract much attention in Europe previous to 
its occurrence at this last place, we shall endeavor to 
be more minute and particular in describing its ap- 
pearance in 1817, and its progress since that time. 



HISTORY OF THE EPIDEMIC CHOLERA 
FROM 1817 TO 1832. 

Dr. Robert Tytler, who practiced medicine at Jes- 
sore, a city situated a little less than one hundred miles 
northeast of Calcutta, was called, on the 19th of Au- 
gust, 1817, by a Hindoo physician, to visit one of 
his countrymen, a Hindoo, who, the preceding night, 



FROM 1817 TO 1832. 27 

had been attacked with violent pains in his bowels, 
accompanied with diarrhea and vomiting. Dr. Tyt- 
ler found the man to be dying, and believed it to be a 
case of poisonings and was about to report so to the 
authorities of the town, when he learned the next day, 
that in the same part of the Bazar,* ten other Hin- 
doos had died with the same symptoms, and in anoth- 
er Bazar, seven others, with a like disease, which had 
attacked many persons in the street. 

It was now no longer possible to mistake an epi- 
demic influence, especially as the number of deaths 
increased rapidly. In 2 months from the invasion of 
the disease, it destroyed more than ten thousand of 
the inhabitants of Jessore. 

Such is the origin of what has been called this new 
pestilence ; and which, since 1817, has prevailed ev- 
ery year in India ; has overrun all parts of it ; and 
which has extended over most of the eastern conti- 
nent ; to New Holland, China, the isle of Bourbon, 
and to the centre of Europe 5 and finally has reached 
this western continent, and appears by its violence at 
Quebec and Montreal, not to have yet lost any of its 
malignancy. 

The resemblance which exists between this dis- 
ease and that long known in Europe as Cholera Mor- 
bus, induced the English physicians to give it the 
same name, and though there are some differences, 
yet it is very true that this Spasmodic Cholera of In- 
dia, resembles more the common Cholera Morbus 
than any other disease yet discribed ; and therefore 

* Bazar, Bazaar, or Basar, a market place in the East, in the 
neighborhood of which are the coffee houses and places of resort 
among the orientals. Bishop Heber, speaking of those at Calcutta, 
says, " they are wretchedness itself," 



28 PROGRESS OF THE 

the name has been well chosen. Indeed many are 
of the opinion that it is in no respect different, but is 
only the common Cholera, prevailing epidemically. 
Sydenham alludes to its prevalence in London, in 
1676. He says, " at the close of the summer, the 
Cholera Morbus prevailed epidemically, and being 
rendered more severe by the extraordinary heat of 
the season, was accompanied with more violent 
and inveterate convulsions, than I had hitherto 
known ; for not only the abdomen, but all the mus- 
cles of the body, and especially those of the arms and 
legs, were affected with terrible spasms." 

In India the disease has received various names. 
The Hindoo physicians call it Vishuchi, or Vishu- 
chiki ; but the common people give it a name which 
signifies vomiting and purging. When it prevailed 
epidemically, and with great severity at Bagdad, in 
1821, it was called by the natives, Haouwa, which 
signifies tornado. 



PROGRESS OF THE CHOLERA IN 1817, 

The first ravages of the Cholera at Jessore, were f 
very considerable ; twenty to thirty people died of it 
each day. At first, the Hindoo population only were 
attacked ; but afterwards, theEuropeans were seized 
with it, and died in great numbers. The evil, for a 
short time, was confined within the walls of Jessore, 
but afterwards it extended to the neighboring cities 
and villages. The first invaded by this epidemic 
were Nuddea and Kishnagur, both situated on a 
small branch of the Ganges. Afterwards, Chitta- 



CHOLERA IN 1S17. 29 

gong, towards the east, and Silhet, on the north, and 
Calcutta, towards the south-west, became the prey 
to this terrible disease. 

Until September, 1317, the Cholera had not ap- 
peared as an epidemic at Calcutta 5 some Hindoos 
were occasionally attacked with it, but the disease 
rarely proved fatal, and for the ten years previous to 
1817, not a single case had been treated at the gene- 
ral hospital for Europeans at Calcutta. But the 
disease appeared at Calcutta as a violent epi- 
demic the first week in September. Few were 
seized in the beginning ; but of those few scarcely 
one survived. Each successive week added strength 
to the malady and more extended influence to its op- 
erations. It has been calculated that 36,000 were 
attacked in the first three months. The proportion 
of men to women who were attacked, was as 4 to 1. 

In the district of Dacca 5 between the Ganges and 
the Burrampooter rivers, the disease made great rav- 
ages in the first six months ; of those attacked, more 
than half died. At Sylhet, a city which contained 
1 9,000 inhabitants, 10,000 persons had the disease 
during the first five months of its prevalence. In the 
district of Nuddea, containing 1,300,000 inhabitants, 
25,500 had the disease, and 16,500 died from it. 

A great number of cities and military stations were 
successively invaded by the Cholera, in the course 
of the year. The principal were those of Balasore, 
Burrisaul, Burdwau, Rungpore, Malda, Baugulpore, 
Chuprah, Monghyr, Buxarand Ghuazeepore. Among 
many, the invasion was so sudden that the roads were 
covered with the dead and the dying, who had not 
time to regain their tents or houses. Men mounted 
on horses were seen to fall from them, unable to rise 
again. 3* 



30 PROGRESS OF THE 

The epidemic this year extended in almost every 
direction around Jessore, to the distance of 250 miles, 
and it has been supposed that at least 600,000 men 
died of Cholera in thirty two cities, during its preva- 
lence in 1817. 

The first week in November, it broke out in the 
grand army under the command of the Marquis of 
Hastings, which was composed of 10,000 English, 
and 80,000 natives, and who were encamped on the 
right bank of the Betoah, and concentrated at Jubel- 
pore, Mendelloa, and Sangor. The first victims were 
very numerous, but on the fifth and sixth days, the 
mortality became so great that despair seized the 
most brave. To the usual noise and gayety of a 
camp, succeeded a mournful silence, or nothing was 
heard but the groans of the dying, and the lamenta- 
tions of those that survived. The principal roads 
and fields around the camp, were strewed with the 
dead bodies of those who, by flight, had hoped to 
have escaped this terrible devastation. No express- 
ion can properly describe the spectacle of desolation 
which this army, recently so brilliant, now exhibited. 
In twelve days, 9,000 men had died, as was ascer- 
tained, and a still greater number had fled. The 
survivors, overwhelmed by so great a disaster, disre- 
garded the voice of their chief, and sought only to 
save their lives, or stun themselves by debauchery. 
Happily, ihe Marquis of Hastings marched his army 
across the Betoah, and fixed his camp on dry and 
elevated ground, and very soon the disease sub- 
sided. 









CHOLERA IN 1818 31 

PROGRESS OF THE CHOLERA IN 1818. 

In 1818, the epidemic cholera spread in every di- 
rection, and over a vast extent of country. It pre- 
vailed on the river Jumna, from its connection with 
the Ganges, to the distance of 200 leagues. Patna, 
Agra, Multra and Delhi, were visited by the disease. 
Patna, containing 250,000 inhabitants, of whom 
1 ,539 died by cholera. At Sharunpore, 250 perished 
out of 30,000 people. Agra suffered severely. At 
Delhi, the victims were numerous. At Benares, 
1 5,000 persons died in two months ; and at Allahabad, 
40 to 50 died in a day. In fine, there were but very 
few cities or villages in the space of 450 square miles, 
following the course upwards of the Ganges and the 
Jumna, that were not ravaged by the cholera in 1813. 
i\t Calcutta, 13,920 persons were attacked in the 
last three months of 1818, and the registers of deaths 
caused by cholera, among the Indians and Mussul- 
men population, show that above 5,000 perished. 

From Bengal, the disease spread to the north, 
towards Nepaul, and to the east, towards the Bir- 
man Empire, on the west, to the coast of Malabar, 
and through the whole extent of the Coromandel 
coast in the south. Traversing the peninsula of In- 
dia, the cholera penetrated, in the month of August, 
1818, the village of Panvvel, and the island of Bom- 
bay, where, in fourteen days, 537 persons were de- 
stroyed by it. 

From Bombay, the epidemic extended itself to- 
wards the north, ravaged Surat, Poonah, Serror and 
Ccllapore. At Poonah, 30 to 40 persons died in a 
day ; and at Serror, 200 Hindoos and 20 Europeans 
died in 24 hours. In the south, Calicut, Cochin, and 



32 PROGRESS OF THE 

several other cities were successively attacked by 
the disease, The disease prevailed to an equal ex- 
tent, in the interior of the peninsula. It appeared 
successively at Husscinabad, Aurengabad, Amena- 
gar, Hydrabad, Seringapatam, Madura, and most of 
the towns even to Cape Comorin. By many it was 
supposed to have been brought into this part of In- 
dia by a detachment of troops that was directed 
from INagporto Jaulnah and Aurengabad. 

In the course of July, the disease appeared atPon- 
derpour, at the time when the celebration of a great 
festival had drawn a great number of people together ; 
at this place, more than 350 died each day, so that 
in a short time 3,000 persons perished of the disease. 
In the month of September, the cholera appeared 
among the inhabitants ofBellary, and afterwards the 
troops at that place were attacked by it. In the 
month of November, it prevailed at Seringapatam, 
and at the same time at Mysore andCoimbatore. 
In this last place, containing 15,000 inhabitants, 70 to 
80 died in a day. 

The cholera prevailed during the first year on the 
Coromandel coast, and extended to Jaggrenah, and 
in 1818 it appeared at JVlasulipatam, and at Fort 
St. George, and Madras. In the months of January 
and February, a number of Hindoos had the disease 
at the fort, and in the course of the year, above three 
thousand Hindoos were attacked, of whom 664 died ; 
and out of 1 1,000 Europeans, 1,087 had the cholera, 
of whom 232 died. In the month of J une, Pondicher- 
ry was invaded by the epidemic, and at the same 
time it prevailed at Carnate and Bellary. 

Towards the east, the epidemic cholera extend- 
ed in 1818, to the Birman Empire, and to the King- 



CHOLERA IN 1819. 33 

dom of Arracan ; and the same year it also prevailed 
in the peninsula of Malacca, though the extent of its 
ravages in that country is not known. 

Its prevalence this year in the north was remark* 
able. It was noticed among the inhabitants on the 
high mountains which separate Hindostan from Na- 
paul, and also in the vallies of Catmandou, Patun 
and Bhatgoun, the elevation of which, is more than 
4000 feet above the level of the sea. 

During the year 1818, its ravages were as great, or 
greater than they have ever been since, in the course 
of one year. 

More than 1 40 cities or villages were visited by it, 
and it extended from the equator to the 28° of north 
latitude, and over an extent of 30 degrees of longi- 
tude. 



PROGRESS OF THE CHOLERA IN 1819. 

In 1819, the progress of the cholera was not so 
great as in the two preceding years. 

It prevailed for a considerable portion of the year 
in Calcutta, but the number of deaths did not exceed 
1459. In the Presidency of Bengal, a great number 
of cities in which the cholera prevailed the year be- 
fore, were visited by it this year also. This was the 
case w 7 ith Nagpore, a city situated in the centre of 
the peninsula, and in which a great number of 
people died with the cholera in the months of April 
and May. 

Many of the military stations were attacked, but 
the disease raged less than in 1818. 

The citadel of Jaragurth, built on an isolated rock, 



34 PROGRESS OF THE 

at a height of 1000 feet above the plain, was visited 
by the epidemic, whilst the inhabitants of a city situ- 
ated at the foot of the mountain entirely escaped. 

The course of the Ganges and the Jumna were 
again visited by the disease. Many cities, as Mora- 
habad, Kiurnaul, Bareilly, Almora and Saharun- 
porte lost many inhabitants. 

The high regions of Nepaul, even to Catmandou, 
were this year spared. 

From Madras, the disease advanced towards the 
south ; passed Trichinopoli ; ravaged Areot, and pre- 
vailed at Cape Comorin. From here, it passed to 
Cochin, Calicut and Bombay. 

On all this coast, a great number of towns which 
had escaped the preceding year, were now desolated 
by a frightful mortality. It has been calculated that 
150,000 people died in the Presidency of Bombay, of 
the disease in 1819. Entire villages were depopula- 
ted, and the terror was so great that the crews of 
many vessels, loaded with cotton, deserted and fled in 
the night. 

At Bombay, it was ascertained that from the month 
of April, 15,945 individuals were attacked by the 
disease, and the Medical Commission affirmed that 
this number was one quarter or one third below the 
true number. The progress of the cholera was very 
extensive on the southeast coast in 181 9. 

The kingdom of Arracan, the peninsula of Malac- 
ca, and the kingdom of Siam, were successively in- 
vaded. At Malacca, more than 400 persons perished 
in a few days. Bankok, the capital of Siam, lost 
more than 40,000 of its inhabitants by cholera. 

As the people attributed this disease to the influ- 
ence of an evil genius, which, under the form of a fish, 



CHOLERA IN 1819. 35 

had sought refuge in the Gulf of Siam, the sovereign 
authority ordered the celebration of a great religious 
solemnity on the coast, in order to exorcise this evil 
being, but the collection at one place of a great mass 
of human beings, redoubled the fury of the disease. 
Eye witnesses stated that of this collection, 7000 died 
of cholera in a ve^ short time. 

Until about the commencement of 1819, the chol- 
era had confined its ravages to the continent, but in 
the month of January, 1619, it appeared at Trinco- 
malee, in the island of Ceylon. By many, it was sup- 
posed to have been imported there, by the vessel Le- 
ander, from Calcutta. After this, it appeared at 
Kandy, the capital city, built on the borders of an ar- 
tificial lake, 1400 feet above the level of the sea, and 
surrounded by wooded hills and mountains. About 
the same time, the disease appeared in the island of 
Penang, situated in the straits of Malacca. Eight 
hundred inhabitants of the English colony of Charles- 
town died in the course of twenty-one days. The 
population of Charles-town was above one thousand, 
two thirds of whom were swept away by the invasion 
of the cholera in 1819. 

The island of Sumatra was also devastated the 
same year by this epidemic. So violent was the dis- 
ease in the capital, Acheen, that the king sought 
refuge at the mouth of the rivef, where he formed a 
camp. But the disease followed to this place, and 
destroyed sixty persons a day. 

This year, the epidemic cholera made its appear- 
ance at a great distance from India, in Mauritius or 
isle of France, a distance of 3000 miles from the other 
places at which the epidemic raged. Its appearance 



36 PROGRESS OF THE 

at this place has given rise to much discussion as to its 
importation. 

It first appeared at Port Louis, the principal town 
in the Isle of France, the 16 th of Nov. 1819. Seven- 
teen days before this, the Topaze, a frigate of 46 guns 
from Ceylon, anchored in the harbor of Port Louis, 
after a very unhealthy voyage, during which, several 
men had died of cholera morbus. 

These circumstances have been appealed to, as 
proof positive that this vessel brought the disease to 
the island ; but it should be recollected that although 
the cholera did not prevail epidemically, or to much 
extent at Port Louis until after the arrival of the ves- 
sel, yet Dr. Kinnis states that several cases occurred 
during the month previous.* 

At first, the disease was confined to Port Louis, 
and out of a population of 8000, destroyed fifty a day, 
for the first ten days. The patients consisted princi- 
pally of the black population of the Mozambique 
caste. These are curly headed negroes ; low in the 
scale of civilization ; too unintelligent to learn trades, 
and generally employed as porters. They are an un- 
interesting quiet race, not given to excess, living chief- 
ly on rice and Indian corn. The disease soon spread 
from the Port to the district of Pamplemouses ; thence 
to the districts of Floeg, Mohebany, and to the Sa- 
vannah, and is said to have destroyed from 10,000 to 
20,000 persons in the island. 

Thus we have seen, that during 1819, the cholera 
extended to many and very distant countries. The 
space over which it spread is about 40 degrees of lati- 
tude, and 50 of longitude. 

J See Edinburgh Medical and Surgical Journal for 1821. 



CHOLERA IN 1820. g 7 

Th» number of cities in which it prevailed during 
the year is about 64, or only one half as many as it 
ravaged in 18L8. 



PROGRESS OF THE CHOLERA IN 1820. 

In 1 320 the Presidency of Bengal was again a prey 
to cholera morbus. A great number of people be- 
longing to the first ranks of society, were attacked by 
it. The disease appeared at the end of February 
Sixty-eight persons perished in the last week of this 
month : 657 died in March : in April and May, the 
number of deaths increased, but in June the mortality 
of the disease diminished rapidly, but it did not en- 
tirely cease until September. 

The course of the Ganges and that of the Jumna 
were also attacked in 1 820. 

Jessore, the cradle of the epidemic, was also visit- 
ed this year by it, but with less intensity than the 
year preceding. 

In the Presidency of Madras, a great number of 
people died in the course of the year. In many cities, 
such as Nagore, Negapatam, Madura, Palamcottah] 
and Tmnevelly, the epidemic commenced in 1819. 
and raged until the middle of 1821. At Madras, in 
1820, there perished of the disease in the army,' 69 
Europeans, and 758 natives. In the other classes of 
the population, the number of deaths was not so 
great. 

The environs of the city, however, suffered severe- 
ly, especially the troops in the camps at Peddapoor 
and Bochuly. Arcot and cape Comorin were again 
invaded by the disease, which spread this year to Co- 

4 



88 PROGRESS OF THE 

chin, and penetrated into the interior, as far as Hy- 
drabad and Nagpor. 

In the month of April, it attacked S urate and its 
environs, afterwards it appeared at Bombay, where 
the greatest mortality prevailed, in the months of May 
and June. 

The islands attacked by the cholera in the course 
of 1820, were Penang, which had already suffered in 
1819, and also Ceylon, where it ravaged Candy and 
Columbo. 

The island of Bourbon also experienced a sfightat- 
tack of the disease. By many it was supposed to 
have been imported into this place from the isle of 
France, as it appeared in January, 1 820, in the isle of 
Bourbon at the same time it prevailed at the isle of 
France, 

The disease this year appeared in the Philippine 
islands, and at Manilla in September, after the arri- 
val of vessels from Bengal. The terror produced at 
Manilla was so great that it caused an insurrection, 
in which perished many Europeans, and a great 
number of the natives. 

The inhabitants of the island of Sumatra were at- 
tacked this year by cholera ; not only those who lived 
on the low grounds and banks of rivers, but those 
who resided on the high lands of the interior. The 
city of Bancoo alone escaped, though in the immedi- 
ate neighborhood, and in free intercourse with places 
where the disease prevailed. This year the cholera 
prevailed at Siam and at Tonquin, and also extend- 
ed to all Cochin China. It appeared at the same 
time at Canton and many other cities of Chin^ 

This year, though a less number of cities hare been 



CHOLERA IN 182i. 39 

attacked by cholera than in 1819, (42 instead of 64,) 
yet it appears that the morbific influence extended 
farther, and comprehended 60° of longitude, and 40° 
of latitude^ 



PROGRESS OF THE CHOLERA IN 1821. 

i# 1821, the cholera invaded countries that it had 
not before visited. The Presidency of Bengal was, 
however, as formerly, the principal seat of the disease. 
At Gorruckpore, the number of deaths was so great, 
that the Rajah and the most part of the inhabitants 
fled. The army encamped on the Nerbudda suffer- 
ed severely from the disease, which also prevailed in 
the cities of Chittagong, Ghazepore, Balassore, San- 
gor, Dacca, and many others. 

The malady reappeared at Calcutta, in the course 
of June. It appeared at Jaggrenah during the annu- 
al religious festival, which brought a great number of 
pilgrims together. The ravages of the cholera were 
so great as to hinder one of the principal ceremonies, 
that which consisted in drawing the car of the idols 
around the temple, so that this year no pilgrim was 
enabled to offer himself as a sacrifice by precipitating 
himself under the wheels of the car. 

Go the Coromandel coast, a great number of cities 
were visited by the epidemic in the course of 1821, 
The principal were Cudalore, Durwar, Salem and 
Madura. At Madras the Indian troops were se- 
verely visited. Pondicherry and Trichinopoli suffer- 
ed very greatly. At St. Thome the missionary, Pierre 
Drujillard, died of cholera, after having fulfilled the 



40 PROGRESS OF THE 

duties of his pious ministry to many of those sick with 
the same disease. 

The cholera also prevailed this year among the 
troops at Jaulnah, in the middle of the peninsula, and 
spread from there to the camp of Venkettagury and 
to Nagpore. The Presidency of Bombay was this 
year the seat of the disease, in its most mortal and 
malignant form. Salsette, Baroda, Poonah, Servor, 
and Surat, were the principal cities affected. In the 
capita], 235 persons died in less than one week. The 
disease prevailed most in May, but in November had 
not entirely disappeared. 

Kishme, an island situated at the entrance of the 
Persian Gulf, was visited by the cholera this year. 
It has been said that the germs of the disease were 
brought here by a convoy of English troops. The dis- 
ease extended itself along the gulf, visited Ormus ? 
Mascate, and Bender Abouehir ; extended also to 
the isle of Bariem, and finally reached Bassora, in 
which city it manifested extraordinary violence. Of 
60,000 inhabitants, 15,000 to 18,000 died of cholera 
in eleven days. From Bassora, it was carried as has 
been supposed to Bagdad, by caravans and vessels on 
the river Tigris* At any rate it appeared at Bagdad 
soon after it raged at Bassora, and according to Dr. 
Meunier, one third of the population of Bagdad were 
destroyed by it. Inhabitants of the suburbs of the 
town, also became affected by the disease, and from 
here the disease spread to the surrounding country. 
A Persian army, which at this time menaced Bagdad, 
recoiled before this new enemy, but carried the dis- 
ease with them into the centre of Persia. At the 
same time the disease spread from Bender Abouchi? 



CHOLERA IN 1821. 41 

to Shiraz, in which city the disease was as mortal as 
at Bassora. Front the frequent communication be- 
tween these places, it would seem as if the disease 
might have been transported by travellers from one 
place to the other, and many writers say this was 
actually the case ; but it is impossible, at this time, 
to obtain all the facts respecting its progress in India 
and Persia, to enable us to determine the important 
question as to the contagiousness of the complaint. 
Besides, this can more easily, and more satisfactorily 
be determined, by an examination of its progress in 
Europe, and within a few years past. 

At Shiraz the disease raged with great violence. 
The Prince Royal lost many persons belonging to his 
harem. Both his mother and son died of the disease, 
and it has been calculated that in 18 days, 6,000 
people died of cholera, out of a population of 35,000. 

On the eastern coast the progress of the disease 
was less extensive, and was chiefly confined to two 
islands in the Indian Archipelago, Borneo and Java. 

In the island of Borneo, the Dutch garrison of 
Pontianah was nearly destroyed •, the resident was 
the only person who was able to administer medi- 
cine. In the island of Java, Samarang was the first 
city invaded by the disease ; afterwards it prevailed 
at Batavia, Sourabaya, Kandal and Japara. At Sa- 
marang, 900 persons perished in seven days. Bata- 
via lost 17,000 inhabitants, and the entire island of 
Java 102,000. 

Such was the progress of the cholera in the course 

of the year 1821. We have seen that it spread from 

places situated under the 40 Q of longitude and 35° 

of north latitude, even to Java, under the 110° of 

4* 



42 PROGRESS OF THE 

longitude, and the 8° of south latitude ; a space of 
43° of latitude and 70°. of longitude. 



PROGRESS OF THE CHOLERA IN 1829. 

The presidency of Calcutta suffered but little from 
the cholera during the course of- this year. It did not 
prevail at Calcutta until the month of December, 
and then but few died of it ; probably owing to the 
adoption of measures to secure the health of the city, 
which until now had not been attended to. The disease 
prevailed again, however, at Jessore, Chittagong, 
and Serampore, though with less violence than for- 
merly. 

The Coromandel coast was invaded by the disease 
at many points, even as far as Cape Comorin. At 
Madras, the troops suffered severely. A vessel an- 
chored near the harbor, lost all her crew, by the 
cholera, excepting two sailors. The vessel William 
Fairlie, lost seven men in five days. " When we re- 
tired for the night," said one of the officers of this 
vessel, " we took leave of each other, certain that we 
should not all meet again." 

The coast of Malabar, and the city of Bombay, 
were not attacked in the course of 1822. On the 
eastern coast, the ravages were less than in the two 
preceding years. 

From Cochin China, where it had been very se- 
vere since 1820, it extended towards China, where 
it raged two years before. Canton, Pekin, and many 
other cities of China lost great numbers of their in- 
habitants. The Philippine islands still continued to 
experience the ravages of this epidemic, but in a lees 



CHOLERA IN 1822. 43 

degree, as this year Manilla was the only place where 
the disease prevailed. 

On the western coast, the progress was towards 
Europe. In Mesopotamia, the disease re-appeared 
in the spring, though it was arrested during the win- 
ter. Bagdad, Mosul, Merdine, and Diarbeker suf- 
fered successively. Many cities in Syria were in- 
fected by the epidemic in the course of the year. 
The cholera also progressed on the side of Persia. 
From Ispahan, where the disease reigned in 1821, it 
reached Kashan in July, 1822, and soon after, Khow, 
Casbin, and Kermandah. In the month of Septem- 
ber, it appeared at Tauris, and extended immediate- 
ly to Erzerum. 

The Prince Royal of Persia having attacked the 
the Turkish army, saw, a few days after the victory, 
his army swept away by the epidemic. It was com- 
puted that 2,000 soldiers died in one march. When 
the army arrived at Tauris, 30 to 40 persons died 
each day. The total number of deaths was 4,800 
in the 25 days that the disease prevailed. This num- 
ber constituted about one twentieth of the population. 
In conclusion, the number of deaths from cholera, 
and the number of cities infected, were much less 
than in the preceding years. Its progress was also 
much less extensive, being confined to ten degrees of 
latitude, — in Persia, Syria, and Mesopotamia, and 
o about the same space in the Chinese Empire* 



PROGRESS OF THE CHOLERA IN 1823. 

In the Presidency of Bengal, only four cities were 
visited by cholera this year, Calcutta, Nagpore, 



44 PROGRESS OF THE 

Kampti and Jaulnah, in each of which, the number 
of deaths was very inconsiderable. The Coroman- 
del coast also suffered but little this year: Madras, 
Trichinopoli, Arcot and St. Thome were the principal 
cities where the disease prevailed. In the Presiden- 
cy of Bombay, the capital alone suffered from the 
cholera, and here it prevailed in a very light degree. 

In general, British India nearly escaped the chol- 
era during the year 1823. It prevailed, to be sure, 
in various parts of the country, but very few died of 
it. But it was very different in the Birman Empire. 
There, its progress was extensive, and the mortality 
very great, notwithstanding the numerous and diverse 
preservatives extravagantly praised by the govern- 
ment. Neither the name of the heir to the crown, 
worn as an amulet around the neck, nor the detona- 
tions made to chase the evil demon from the country, 
were able to arrest the progress of the epidemic, or to 
lessen its mortality. 

In China the ravages of the cholera were also great, 
in consequence of the numerous canals, and the im- 
mense population of the country. The Russian au- 
thorities urged the Mandarins to arrest the disease by 
adopting some preventive or preservative measures. 
But they were told in answer, that the malady would 
give more space in the w r orld to those who survived it, 
and besides, that the cholera chose its victims from 
among the filthy and the intemperate, and that no per- 
son of courage, who lived with moderation and sur- 
rounded by cleanliness, would die of the disease. On 
this occasion, the Mandarins stated that the Emperor 
had said to his subjects, " Do not believe the disease is 
more powerful than yourselves ; timid people are the 
only ones who die of it." And it was added that 



CHOLERA IN 1823. 45 

after this the people took courage, and the disease 
left the country. But the vast provinces of China 
were not the less ravaged by the epidemic, which 
extended even to Kukuchoton, a Russian city north 
of Pekiu, in the 40° of north latitude. Macao and 
Nankin also suffered very much from the disease. 

The progress of the cholera was also considerable 
on the western coast. The north of Persia continued 
to be the seat of the epidemic in its most mortal form, 
and from here it penetrated into the Russian territory 
by two points, Gilan Suillau on one side, and Astra- 
chan on the other. Jn this last city, 216 had the dis- 
ease, 144 of whom died. The borders of the Medi- 
terranean, and also those of the Caspian sea, were 
this year visited by the cholera. It prevailed at 
Lataquiein June, 1823, and afterwards at Antioch, 
Tortose, Tripoli and Luedie, though not with great 
severity. From here it spread to Damir in the neigh- 
borhood of Damascus. On the other side, it spread to 
the foot of mount Libanon, and threatened Palestine. 
The most northerly point where the cholera ap- 
peared this year was Orenbourg, a city situated on 
the confines of Asia and Europe. At this city, nume- 
rous caravans arrived yearly, by two different ways. 
Those fromBucharia and China, and which traversed 
Chinese Tartary, arrived from the east, while those 
*that brought merchandise from Hindostan, and tra- 
Iversed the territory of the Kirghises arrived from the 
[ south. By either of these ways the cholera might 
have been brought to Orenbourg, for the disease pro- 
availed both at China and Hindostan. The first in- 
vasion of the disease at Orenbourg was not formida- 
ble, but few died of it, and it did not extend far into 
the surrounding provinces. 



46 PROGRESS OF THE 

In the course of the year 1823 the cholera prevail- 
ed but little in those places where it had formerly 
raged, it extended however to the frontiers of Europe* 
to Astrachan and Orenbourg. 

The appearance of the disease on the borders of the 
Mediterranean created great alarm, in consequence 
of the frequent communication which existed be- 
tween Europe and the ports of Syria ; but now, 
events have shown that such fears were not well 
founded, as the disease has not penetrated into Eu- 
rope by maratime communications, but has passed by 
land from one country to another. 



PROGRESS OF THE CHOLERA IN 1824. 

But few countries were visited by the cholera in 
i824. In British India it prevailed but very little^ 
and only in a few cities* Calcutta lost a few hun- 
dred inhabitants by the epidemic in the course of the 
year. At Madras, the army suffered but little, while 
the vessels anchored near the fort lost great numbers 
of their crews. 

The coast of Malabar, and the capital of the prov- 
ince were invaded at some points. But the ravages 
of the epidemic w 7 ere very inconsiderable, though 
they attracted great attention by the rank of the vic- 
tims of the disease, who belonged to the most wealthy 
and elevated classes in society. 

On the eastern coast, the Birman empire and the 
northern provinces of China w 7 ere the only countries 
infected by the disease in 1824. 

The towns in the west, in Persia and Arabia, 
where the disease had prevailed with frightful mortal- 



CHOLERA IN 1825. 47 

ity for three years past, this year were entirely ex- 
empted from the epidemic. Mesopotamia was also 
delivered this year from the complaint, which raged 
there with great severity the year preceding. In 
Syria, the city of Tiberiade was the only one where 
the cholera appeared, and here the cold of winter put 
an entire stop to it. 

In conclusion, the march of the destroying epidem- 
ic which had menaced both Europe and Africa, seem- 
ed to be arrested in the year 1824. 



PROGRESS OF THE CHOLERA IN 1825. 

The Presidency of Calcutta again saw the cholera 
reappear and prevail with greater violence than in 
the course of the year 1824. More than 500 persons 
died in Calcutta, daily, in August and September. 

At Jessore, the disease again appeared and destroy- 
ed more than thirty a day. 

At Benares, more than 6000 Hindoos died of chol- 
era in the course of the summer. Many other cities, 
such as Mirapore, Dinapore, Gasepore, Chunar, &c, 
were infected in the course of the autumn. The Co- 
romandel coast was more fortunate than Calcutta, as 
the disease had not visited it for two years. 

At Bombay, the return of the disease created great 
alarm. The inhabitants built hospitals for those sick 
with cholera; they set fire to immense masses of 
wood in the infected districts, and burnt large quan- 
tities of vinegar, tar and gun powder. The environs 
* of Bombay also suffered from the disease, which ex- 
tended to Surat on the north, and Belgaum and Cola- 
pore in the country of the Marattes. In Western 



43 PROGRESS OF THE 

Asia, Arracan and the empire of the Birmans were 
the only places infected by the disease in 1825, and 
it is said that the north of China and Chinese Tartary 
suffered greatly from the disease in the course of this 
year. 



PROGRESS OF THE CHOLERA IN 1826. 

The Presidency of Calcutta suffered but little this 
year from the epidemic. At the city of Calcutta, the 
Hindoos perished in considerable numbers. Patna 
and Benares experienced the same calamity. In this 
last city, the disease destroyed one hundredth part of 
the population. The Goromandel coast was, as in 
1825, completely preserved from the disease. On 
the coast of Malabar, only a small number of cities 
were infected, but when the disease did prevail, it 
was so mortal that indescribable terror seized the 
people, who fled at its approach, 

In eastern Asia, the epidemic continued to progress 
towards the north — passed -the great wall of China, 
and visited Kukuchoton, a Russian city, situated on 
the 42 Q of north latitude. From there, it penetrated, 
perhaps by the aid of caravans, from Kiachta, even 
to the centre of Asiatic Russia. 

Western Asia was this year completely exempted 
from this epidemic which had ravaged it for five years. 
In conclusion, there has been no year since the com- 
mencement of the disease in 1817, in which so few 
cities were infected. According to M. Moureau de 
Jonne's there were only five ; but this number is 
probably below the truth. It is certain, nevertheless, 
that the diminution of this malady gave birth to the 



CHOLERA IN 1827. -* 49 

hope that its ravages, which, for ten years, had ex- 
tended over a considerable portion of the world, were 
now about to cease. 



PROGRESS OF THE CHOLERA IN 1827. 

From the month of January, the city of Calcutta 
was infected by the cholera. First, the garrison was 
attacked, and afterwards the Hindoo population, 
which sickened in great numbers. The animals also 
experienced the epidemic influence, and to such a 
degree, that they were killed in great numbers. The 
prolongation of the epidemic gave rise to various and 
singular conjectures and opinions. The Europeans 
attributed it to the heat of the sun and the coldness 
of the nights; whilst the Hindoos considered it to 
arise from the anger of the Divinity or God of the 
Cemeteries, in consequence of the cessation of hu- 
man sacrifices. 

At Palcal, a Hindoo woman resolved to burn her- 
self on the body of her husband, who had died of 
cholera, but the Rajah refused to authorize such a 
procedure. The widow, however, was urgent in her 
request, and declared that the cholera would cease in 
five days if she might be permitted thus to sacrifice 
herself. The Rajah yielded to this assurance, and 
permitted the sacrifice ; but the disease was not seen 
to lessen. 

Many cities in the Presidency of Bengal and of 
Hindostan, were invaded by the cholera, in the 
course of the year, the principal of which, were Jes- 
sore, Jaypour, Jubulpore, Rewa, Sangor, &c. The 
disease prevailed also at some places on the Coro-% 



50 PROGRESS OF THE 

mandel coast; at Madras, Jaulnah, Hyderabad and 
Husserabad ; but every where, it was, this year, 
less malignant than it had been during the preceding 
years. This was particularly the case at Bombay, 
where only a very few died of the disease in 1827. 

At the north, the cholera appeared at different pla- 
ces. On one side, it reached the high grounds in the 
neighborhood of the Himaleh mountains, and on 
the other it opened to itself a new route towards Eu- 
rope, from the centre of Asia. It passed from Lahore 
to Cashgar, and to Caboul, where it prevailed several 
months. From this last city, which is the great em- 
porium of the merchandize oflndia, it was supposed to 
have been transported with the caravans, to the bor- 
ders of the Caspian sea. By this route, Persia on 
the west, and Russia on the north, appeared to have 
received the disease in 1828 and 1829. At the east, 
we see the disease extend itself further into Chinese 
Tartary, and into Russia in Asia, where it had al- 
ready prevailed in 1826. 



PROGRESS OF THE CHOLERA IN 1828. 

As in the four preceding years, the ravages of the 
cholera in 1828 were not great, and were confined 
almost exclusively to British India. In the neighbor- 
hood of Calcutta, more died of the disease than for- 
merly ; several villages were entirely depopulated. 
The mountainous districts of Kemaon, Almorah, 
Cawnpore and Chittagong, were successively affect- 
ed with the cholera. 

At Madras, the disease did not appear before the 
month of August ; but then it destroyed a great num- 



CHOLERA IN 182& 51 

ber of Europeans. All the coast was ravaged by 
the disease even to Trichinopbli, where it prevailed 
until the end of December. On the coast of Mala- 
bar, Bombay was nearly the only city where the dis- 
ease prevailed in 1828 5 but here the victims belong- 
ed to all classes of society •, the rich and the poor, of- 
ficers and soldiers, Europeans and Hindoos, were 
alike affected and destroyed by the malady. 

This year, the cholera continued its march towards 
the north. From Lahore, where it destroyed 30,000 
inhabitants in 1827, it extended to the neighboring 
towns, in the autumn of 1828. But the cold very 
soon mitigated its violence, and lessened its rav- 
ages. 



PROGRESS OF THE CHOLERA IN 1829, 

The disease did not, this year, appear in the Presi- 
dency of Bengal. Madras, Madura, Verdaputty and 
Royapettah, were nearly the only cities visited by 
the cholera on the Coromandel coast, in the course of 
the year 1 829. At Bombay, there were a few cases, 
but the disease exibited nothing remarkable. 

The cholera appeared anew in Persia in 1829. 
The precautions taken to prevent the disease being 
imported into Teheran, in 1822, and which were sup- 
posed to have prevented its appearance there at that 
time, were said to have been neglected in 1829, and 
the disease appeared there towards the end of Octo- 
ber. It was supposed to have been brought there by 
communication with Caboul. The severity of the 
cold season, however, prevented the disease prevail- 



52 PROGRESS OF THE 

with great violence, and after a few weeks it entirely 
disappeared. 

During this year, the cholera, as if impatient of the 
limits within which it had hitherto been confined, 
crossed the Ural mountains, which separate Asia from 
Europe, and appeared in the city of Orenbourg, lying 
in the 51° of north latitude, and 72° of east longitude. 
This city is situated upon the river Ural, between 
two chains of the Ural mountains, in a spacious and 
open valley, extending in a direction from northeast 
to southwest, and contains 11,000 inhabitants, of 
which number, six thousand are soldiers. The first 
case was that of a soldier in the garrison at Oren- 
bourg. He was attacked on the morning of the 26th 
of August, and died in 12 hours. One week after, a 
woman died of suspicious symptoms, and after anoth- 
er week, on the 8th of September, another suspicious 
and fatal case occurred. Neither of these persons 
had any communication with any infected place, and 
no trace whatever could be found of the way in 
which the cholera arrived at Orenbourg. The next 
day, two other cases occurred, and on the 10th of 
September, two more, after which, the disease spread 
rapidly, and became prevalent. Between this time 
and the 20th of November, when the disease entirely 
ceased, 1,100 cases occurred, of which 200 died. No 
other place in the Orenbourg government was visited 
by the disease, until the 23d of September, when it 
broke out at Rasufina, 60 miles west of Orenbourg ; 
soon it appeared at other places, and by the middle 
of November, it had spread over a district of country 
200 miles square $ but by the 23d of February, 1830, 
the disease was every where extinct in the Oren- 
bourg government. 



CHOLERA IN 1830. 53 

PROGRESS OF THE CHOLERA IN 1830. 

This year the cholera spread over various provin- 
ces around the Caspian sea. It was noticed at sev- 
eral places in the Persian province of Ghilan. It 
prevailed all along the shores of the Caspian, — at 
Sherran, Maranderen, Reschd and Baku. In the 
town of Taurus, the mortality was not less than 5,000. 
It appeared at Tiflis, the capital of Georgia, on the 
27th of July, and in ten days attacked 579 persons, 
of whom 237 died. The city of Tiflis was nearly 
depopulated by death and flight, which reduced the 
number of the inhabitants from 30,000 to 8,000. In 
this city, the rites of religion were interposed to stay 
the calamity. 

On the 19th of July, the disease reached Astrachan, 
where it had prevailed several years before. Astra- 
chan is a large town, situated on an island in the prin- 
cipal mouth of the Volga, about thirty miles from the 
northern shore of the Caspian. The town contains, 
according to Malte-Brun, from 40 to 70,000 inhabit- 
ants. In ten days after the disease first appeared, 1 ,229 
persons were attacked, of whom 433 died. 

From Astrachan it spread along the Volga river, 
and appeared at Taritsin, 220 miles above Astra- 
chan, by the 4th of August, and at Saraton, 200 miles 
further north, on the 6th of the same month. After 
this, it extended to the government of Kien, 500 miles 
west of the Volga. On the 27th of August, it ap- 
peared at Samarov, a town on the Volga, 200 miles 
north east of Saraton ; and by the last of the month, 
it reached Nischnei Novgorod* On the 9th of Sep- 
tember, it broke out at Kasan, two hundred miles 

down the Volga ; and about the same time, at Kos- 

5* 



54 PROGRESS OF THE 

troma, two hundred miles up the river ; and on the 
15th of September, it arrived at Moscow, about two 
months and a half after its second appearance at As- 
trachan. 

The occurrence of the disease in Moscow occasion- 
ed great alarm ; 50,000 persons are said to have fled 
the city in a few days. More than 200 cases were 
reported in the first twelve days, and at the height of 
the epidemic, 244 persons were attacked in one day. 
The consternation was great throughout the Russian 
Empire. The Emperor liberally offered a reward of 
25,000 rubles, (about #5,000,) for the best disserta- 
tion on the nature, causes, prevention, cure, &c of 
cholera. A council of health was formed at Mos- 
cow, composed of physicians from Paris, Berlin, Got- 
tingen, and other places, who, after having devoted 
themselves to the study of the epidemic, reported, 
that at the end of three months, more than 8,000 ca- 
ses had come under their observation, and that of 
this number, more than one half had died. The dis- 
ease had, however, nearly subsided in Moscow at 
the close of the year 1830. 



PROGRESS OF THE CHOLERA IN 1831. 

Early in the spring of 1831, the cholera re-appear- 
ed in Europe. It was seen in the north, as far as 
Archangel, and in the west, at the Baltic sea; 
Spreading to the south and west, it reached Warsaw 
about the middle of April. Here it attacked all 
ranks and ages, though most prevalent among the 
lower orders. In July, its ravages were very great, 
not only in Warsaw, but in almost every village of 



CHOLERA IN 1831. 55 

unfortunate Poland. In May, it broke out in 
Riga, where it raged until late in J uly. It also pre- 
vailed at the same time at Polangen, Dantzic, and 
other ports on the Baltic. 

On the 26th of June, the cholera appeared in the 
imperial city of St. Petersburg. The Czar became 
terrified, and with his court retired from the city, 
and surrounded himself with a cordon rnilitaire^ 
allowing no approach from without. Thousands of 
the inhabitants of St. Petersburg fled the city to pla- 
ces where the disease had not prevailed. At one pe- 
riod, from five to six hundred new cases occurred dai- 
ly, but towards the end of July the epidemic gradually 
subsided, and by the 15th of August the disease had 
entirely ceased, and the fugitives returned to their 
homes. 

About the same time that the disease prevailed at 
St. Petersburg, it also appeared at Archangel, on the 
Dwina, near the White sea, and at Odessa on the 
Black sea. It broke out at Mecca, about the first of 
May, 1831, at the time when innumerable pilgrims 
from every part of the empire were collected there to 
visit the holy places. It is said that of 50,000 pilgrims 
to the shrine of Mecca in 1831, about 20,000 perished 
of the cholera. 

The disease appeared at Berlin in the course of 
this year. It was officially announced as prevailing 
there the first of September, but a few cases had been 
noticed during the month previous. At first, the dis- 
ease at Berlin was very violent, but after a few weeks 
it assumed a much less malignant character, and by 
the end of the year had almost entirely disappeared. 
The disease prevailed at Berlin about three months 
and a half. The greatest number of new cases oc- 



56 PROGRESS OF THE 

curred about the third week after the disease broke 
out, and the greatest number of deaths the following 
week. From the 1st of September, to the middle of 
December, the number of cases which had occurred 
at Berlin amounted to 2,230, and the number of 
deaths to 1,407. 

The disease prevailed this year to a great extent in 
Hungary, and the numerous communications which 
existed between Hungary and Austria, by means of 
the Danube, created great fears in Vienna, the capital 
of Austria. The city was surrounded by a double 
cordon, but notwithstanding this precaution, the dis- 
ease appeared the 16th of August, though the author- 
ities did not acknowledge the disease to exist in Vi- 
enna until the 15th of September, At this time it 
raged with great violence. During the first week 
764 cases occurred, and 303 deaths ; after this, the 
disease diminished. The disease prevailed at Vien- 
na about three months, during which period 4046 
cases were noticed, and 1936 died of the disease. 
The cholera at Vienna destroyed more of the nobility 
and people belonging to the upper classes of society 
than it ever had at any other place : and it was like- 
wise more fatal here, than it had ever before been no- 
ticed, to the physicians and other attendants on the 
sick. 

The cholera also prevailed this year at Constanti- 
nople. The Turkish government did not however 
establish any quarantines, but distributed gratuitous- 
ly, small pamphlets throughout the empire, giving a 
history of the disease, the means of guarding against 
it, and the best treatment to be employed. Its rava- 
ges at Constantinople were not very great, but it pre- 
vailed with great severity at Smyrna. 






CHOLERA IN 1832. g? 

The cholera first appeared at Hamburgh on the 
11th of October, though not with great severity, as out 
of a population of 100,000, only 874 had the disease, 
and 455 died. 

The 26th of October, the Board of Health of Sun- 
derland in England, officially announced that the 
cholera existed there. A few cases of the same dis- 
ease had been noticed in August previous, but it did 
not prevail epidemically until the last of October. 

All attempts to prove that the disease was import- 
ed into Sunderland and England, have as yet failed, 
and the opinion that it was not imported at all, has 
become very general, not only at Sunderland, but 
throughout England, and especially among the mem- 
bers of the medical profession. 

In a few weeks after the first appearance of the 
cholera at Sunderland, it broke out at New Castle, 
Gateshead, and numerous places in that vicinity, and 
the 17th of December, it first appeared in Scotland, 
at Haddington, a town situated on the river Tyne^ 
distant about 17 miles from Edinburgh, and 100 from 
New Castle. 



PROGRESS OF THE CHOLERA IN 1832. 

The progress of the cholera since the commence- 
ment of the present year, has been greater in extent 
than during any previous year, for not only has it 
spread to most of the great towns in Europe, but the 
mighty epidemic has now reached this western con- 
tinent 5 and this country, which has until the present 
year escaped the ravages of a general pestilence, is at 
present overshadowed by the angel of death. 



88 PROGRESS OF THE CHOLERA IN 1832. 

The cholera appeared at Edinburgh, the 27th of 
January, 1832, but its ravages in that city were not 
great. It also appeared about the same time at vari- 
ous places in the neighborhood of Edinburgh and 
Glasgow, and early in the year it reached London, 
the largest city ever visited by pestilence ; but very 
unexpectedly its ravages in this modern Babylon 
were very inconsiderable. It appeared for the first 
at Paris, the 24th of March, and in this splendid city 
it prevailed with great severity. It also appeared in 
many other towns in France. Soon after this, it 
broke out in Dublin, and other towns in Ireland, and 
it now appears to be prevailing, though in a mitigated 
form, in numerous places in England, Ireland and 
France.* 

The first appearance of cholera on this continent, 
was at Quebec, where it broke out as an epidemic of 
great malignity, the 8th of June. Less than one 
week after this, it appeared at Montreal, where it has 
prevailed with uncommon violence. 

The last week in June, the disease appeared at 
New York, and about the same time at Albany, but 
as the facts connected with the first appearance of 
the cholera in this country, and its subsequent pro- 
gress, are imperfectly known at present, we refer the 
reader for further details, to the appendix to this 
work.t 

* For further details respecting the recent progress of the chol- 
era in Europe, see Appendix, note A. 
f See Appendix, note B. 



HISTORY OF THE SYMPTOMS OF CHOLERA. 59 

HISTORY OF THE SYMPTOMS OF CHOLERA. 

Having brought down the history of the epidemic 
cholera to the present time 5 having traced its rava- 
ges year after year, from 1817 to 1832 ; having fol- 
lowed it from India to Europe, and from Europe to 
North America, we shall now proceed to describe 
the symptoms of the disease as they have been wit- 
nessed in the different countries where it has pre- 
vailed. 

The symptoms of this disease have been nearly the 
same in all countries. In all countries, some patients 
have experienced premonitory symptoms for several 
hours or days, such as diarrhea, nausea, and slight 
vomiting ; and in all countries, some have been pros- 
trated at once by the disease, as if by a blow ; such 
become suddenly cold, the pulse ceases, and they ex- 
pire in a short time. 

In all countries, the following have been among the 
most prominent and essential symptoms of the dis- 
ease. Immediate sinking of the circulation, coldness 
of the skin, tongue, &c, vomiting, purging and spasms, 
and a livid or blue or blackish color of the lips and 
surface of the body. The skin of the hands and feet 
becomes corrugated, and assumes a dark color, as if 
these members had been soaked for a long time in a 
pale blue dye. Generally, the patients manifest 
great desire for cold water to drink, and even when 
the tongue and mouth are moist and cold. Such 
were the symptoms of the cholera in India, in Russia, 
in England and Canada, as they have been described 
by those who have witnessed much of the disease at 
those places. Such are the symptoms which I have 



60 HISTORY OF THE 

just witnessed at New York, among those affected 
by the disease. Indeed, many of the descriptions of 
the disease as it appeared in India, would be very ac- 
curate and just descriptions of the disease as it now 
prevails in this country. 

The following history of the symptoms of the choU 
era, as they were first noticed in India, was drawn up 
by the Bengal Medical Board, and was considered 
so accurate, that the Bombay Medical Board thought 
proper to adopt it, and embody it in their report : 

" The attack was generally ushered in by sense of 
weakness, trembling, giddiness, nausea, violent retch- 
ing, vomiting and purging of a watery, starchy, whey- 
colored, or greenish fluid. These symptoms were 
accompanied, or quickly followed by severe cramps ; 
generally beginning in the fingers and toes, and 
thence extending to the wrists and fore-arms, calves 
of the legs, thighs, abdomen, and lower part of the 
thorax. These were soon succeeded by pain, con- 
striction, and oppression of the stomach and pericar- 
dium 5 great sense of internal heat ; inordinate thirst, 
and incessant calls for cold water, which was no soon- 
er swallowed than rejected, together with a quantity 
of phlegm, or whitish fluid, like seethings of oatmeal. 
The action of the heart and arteries now nearly ceas- 
ed ; the pulse either became altogether imperceptible 
at the wrists and temples, or so weak as to give to the 
finger only an indistinct feeling of fluttering. The 
respiration was laborious and hurried ; sometimes 
with long and frequently broken inspirations. The 
skin grew cold, clammy, covered with large drops of 
sweat, dank and disagreeable to the feel, and disco- 
lored, of a bluish, purple, or livid hue. There was 
great and sudden prostration of strength 5 anguish 



SYMPTOMS OF CHOLERA. 61 

and agitation. The countenance became collapsed ; 
the eyes suffused, fixed, and glassy, or heavy and dull ; 
sunk in their sockets, and surrounded by dark cir- 
cles ; the cheeks and lips livid and bloodless ; and the 
whole surface of the body nearly devoid of feeling. 
In feeble habits, where the attack was exceedingly 
violent, and unresisted by medicine, the scene was 
soon closed. The circulation and animal heat never 
returned ; the vomiting and purging still continued, 
with thirst and restlessness ; the patient became de- 
lirious or insensible, with his eyes fixed in a vacant 
stare, and sunk down in the bed ; the spasms increas- 
ed, generally within four or five hours. 

" The disease sometimes at once, and as if it were 
momentarily, seized persons in perfect health ; at 
other times, those who had been debilitated by previ- 
ous bodily ailment, and individuals in the latter pre- 
dicament, generally sunk under the attack. Some- 
times the stomach and bowels were disordered for 
some days before the attack ; which w 7 ould then come 
on in full force, and speedily reduce the patient to 
extremities. 

-" Such was the general appearance of the disease 
where it cut off the patient in its earlier stages. The 
primary symptoms, however, in many cases, admit- 
ted of considerable variety. Sometimes, the sickness 
and looseness were preceded by spasms. Sometimes, 
the patient sunk at once, after passing off a small 
quantity of colorless fluid by vomiting and stool. The 
matter vomited in the early stages was, in most cases, 
colorless, or milky -, sometimes it was green. In like 
manner, the dejections were usually watery and mud- 
dy ; sometimes red and bloody ; and in few cases, 
they consisted of a greenish pulp, like half digested 



62 HISTORY OF THE 

vegetables. In no instance was feculent matter pass- 
ed in the commencement of the disease. The 
cramps usually began in the extremities, and thence 
gradually crept to the trunk ; sometimes they were 
simultaneous in both ; and sometimes the order of 
succession was reversed ; the abdomen being first af- 
fected, then the hands and feet. These spasms hard- 
ly amounted to general convulsion. They seemed 
rather affections of individual muscles, and of partic- 
ular sets of fibres of those muscles ; causing thrilling 
and quivering in the affected parts, like the flesh of 
crimped salmon ; and firmly stiffening and contorting 
the toes and fingers. The patient always complain- 
ed of pain across the belly 5 which was generally pain- 
ful to the touch, and sometimes hard and drawn back 
towards the spine. The burning sensation in the sto- 
mach and bowels was always present, and at times ex- 
tended along the cardia and oesophagus to the throat. 
The powers of voluntary motion were in every in- 
stance impaired, and the mind obscured. The pa- 
tient staggered like a drunken man ; or fell down like 
a helpless child. Headach, over one or both eyes, 
sometimes, but rarely occurred. The pulse, when 
to be felt, was generally regular, and extremely fee- 
ble, sometimes soft, not very quick ; usually ranging 
from 80 to 100. In a few instances, it rose to 140 or 
150, shortly before death. Then it was distinct, 
small, feeble, and irregular. Sometimes very rapid, 
then slow for one or two beats. The mouth was hot 
and dry ; the tongue parched, and deeply furred, 
white, yellow, red, or brown. The urine at first gen- 
erally limpid, and freely passed ; sometimes scanty, 
with such difficulty as almost to amount to strangua- 
ry ; and sometimes -hardly secreted in any quantity, 



SYMPTOMS OF CHOLERA. 63 

as if the kidneys had ceased to perform their office. 
In a few cases, the hands were trenaulous. In others, 
the patient declared himself free from pain and unea- 
siness ; when want of pulse, cold skin, and anxiety 
of features, portended speedy death. The cramp 
was invariably increased upon moving. 

" Where the strength of the patient's constitution, 
orthe curative means administered, were, although in- 
adequate wholly to subdue the disease, sufficient to re- 
sist the violence of its onset ; nature made various ef- 
forts to rally ; and held out strong, but fallacious prom- 
ises of returning health. Tn such cases, the heat was 
sometimes wholly, at others, partially restored ; the 
chest and abdomen in the latter case becoming warm, 
whilst the limbs kept deadly cold. The pulse would 
return ; grow moderate and full ; the vomiting and 
cramps disappear ; the nausea diminish ; and the 
stools become green, pitchy, and even feculent, and 
with all these favorable appearances, the patient 
would suddenly relapse ; chills, hiccup, want of sleep, 
and anxiety would arise ; the vomiting, oppression, 
and insensibility return, and in a few hours terminate 
in death. 

" When the disorder ran its full course, the follow- 
ing appearances presented themselves: — What may 
be termed the cold stage, or the state of collapse, usu- 
ally lasted from 24 to 48 hours, and was seldom of 
more than three complete days' duration. Through- 
out the first 24 hours, nearly all the symptoms of 
deadly oppression, the cold skin, feeble pulse, vomit- 
ing and purging, cramps, thirst, and anguish, contin- 
ued undiminished. When the system show r ed symp- 
toms of revival ; the vital powers began to rally ; the 
circulation and heat to be restored ; and the spasms 



64 HISTORY OF THE 

and sickness to be considerably diminished. The 
warmth gradually returned ; the pulse rose in 
strength and fulness, and then became sharp, and 
sometimes hard. The tongue grew more deeply fur- 
red ; the thirst continued, with less nausea. The 
stools were no longer like water ; they became first 
brown and watery ; then dark, black, and pitchy ; 
and the bowels, during many days, continued to dis- 
charge immense loads of vitiated bile, until, with re- 
turning health, the secretions of the liver and other 
viscera gradually put on a natural appearance. The 
fever which invariably attended this second stage of 
the disease, may be considered to have been rather 
the result of nature's effort to recover herself from the 
rude shock which she had sustained ; than as form- 
ing any integrant and necessary part of the disorder 
itself. It partook much of the nature of the common 
bilious attacks prevalent in these latitudes. There 
was the hot, dry skin •, foul, deeply furred, dry tongue ; 
parched mouth ; sick stomach ; depraved secretions, 
and quick variable pulse 5 sometimes with stupor, de- 
lirium, and other marked affections of the brain* 
When the disorder proved fatal, after reaching this 
stage, the tongue, from being cream-colored, grew 
brown, and sometimes dark, hard, and more deeply 
furred ; the teeth and lips were covered with sordes ; 
the state of the skin varied, chills alternating with 
flushes of heat ; the pulse became weak and tremu- 
lous ; catching of the breath; great restlessness, and 
deep moaning succeeded : and the patient soon sunk, 
insensible, under the debilitating effects of frequent, 
dark, pitchy, alvine discharges." 

The following account of the invasion of the dis- 
ease, and its symptoms, resemble very much the fore- 



SYMPTOMS OF CHOLERA 65 

going, and are equally interesting. It is taken from 
the Report of the Madras Medical Board, drawn up 
by order of the Government, by Wm. Scott, surgeon, 
and secretary to the Board, and was published at 
Madras in 1824. The accompanying remarks are 
from the Edinburgh Medical and Surgical Journal, 
for 1825. 

"The invasion of the cholera generally takes place 
in the night, or towards morning. The patient is 
sick at stomach ; he vomits its contents, and his bow- 
els are at the same time evacuated. This evacua- 
tion is of a nature quite peculiar to the disease ; the 
entire intestinal tube seems to be at once emptied of 
its faecal or solid matters ; and an indescribable, but 
most subduing feeling of exhaustion, sinking, and 
emptiness is produced. Faintness supervenes, the 
skin becomes cold, and there is frequently giddiness, 
and ringing in the ears. The powers of locomotion 
are generally soon arrested ; spasmodic contractions, 
or twitchings of the muscles of the fingers and toes 
are felt ; and these affections gradually extend along 
the limbs, to the trunk of the body. They partake 
both of the clonic and tonic spasm, but the clonic 
form chiefly prevails. The pulse, from the first, is 
small, weak, and accelerated ; and, after a certain 
interval, but especially on the accession of spasms, 
or of severe vomiting, it sinks suddenly, so as to be 
speedily lost in all the external parts. The skin, 
which, from the commencement of the disease, is be- 
low the natural temperature, becomes colder and 
colder. It is very rarely dry ; generally covered with 
a profuse cold sweat, or with a clammy moisture. 
In Europeans, it often partially assumes a livid hue ; 
the whole surface appears collapsed, the lips become 



66 HISTORY OF THE 

blue, the nails present a similar tint ; and the skin of 
the feet and hands become much corrugated, and 
exhibits a sodden appearance. In this state the skin 
is insensible, even to the action of chemical agents; 
yet the patient generally complains of oppressive 
heat on the surface, and wishes to throw off the bed 
clothes. The eyes sink in their orbits, which are sur- 
rounded by a livid circle; the comae become flaccid, 
the conjunctiva is frequently suffused with blood ; the 
features of the face collapse, and the whole counte- 
nance assumes a cadaverous aspect, strikingly char- 
acteristic of the disease. There is almost always ur- 
gent thirst, and desire for cold drinks, although the 
mouth be not usually parched. The tongue is moist, 
whitish, and cold. A distressing sense of pain and of 
burning heat at the epigastrium are common. Little 
or no urine, bile, or saliva, is secreted. The voice 
becomes feeble, hollow, and unnatural. The respi- 
ration is oppressed, generally slow, and the breath is 
deficient in heat. 

" During the progress of these symptoms, the ali- 
mentary canal is very variously affected. After the 
first discharges by vomiting and purging, however se- 
vere these symptoms may be, the matter evacuated 
is always watery, and in a great proportion of cases 
it-is colorless, inodorous, and often homogeneous. In 
some, it is turbid, resembling muddy water ; in oth- 
ers, it is of a yellowish or greenish hue. A very com- 
mon appearance is that, which has been emphatically 
called the " conjee stools,' 5 an appearance produced 
by numerous mucous flakes floating in the watery or 
serous part of the evacuation. The discharges from 
the stomach, and those from the bowels, do not ap- 
pear to differ, except in the former being mixed with 



m 



SYMPTOMS OF CHOLERA. 67 

the ingesta. N either the vomiting nor the purging are 
symptoms of long continuance. They are either ob- 
viated by art, or the body becomes unable to perform 
these violent actions ; and they, together with the 
-spasms, generally disappear a considerable time be- 
fore death. If blood be drawn, it is always dark," or 
almost black, very thick, ropy, and generally of slow 
and difficult effusion. Towards the close of the at- 
tack, jactation comes on, with evident internal anx- 
iety and distress : and death takes place, often in 
ten, or twelve, generally within eighteen or twenty, 
hours from the commencement of the attack. 

" During all this mortal struggle and commotion in 
the body, the mind remains clear, and its functions 
undisturbed, almost to the last moment of existence. 
The patient, though sunk and overwhelmed, listless, 
averse to speak, and impatient of disturbance, still 
retains the power of thinking, and of expressing his 
thoughts, as long as his organs are obedient to his will. 
Such is the most ordinary course of cholera asphyxia, 
when its tendency to death is not checked by art. 

" A favorable issue is denoted by a rising of the 
pulse, a return of heat to the surface, inclination to 
natural sleep, and a diminution or cessation of vomit- 
ing, purging, and spasms ; these indications being 
succeeded, after an interval, by the re-appearance of 
foecal matter in the stools, of bile, of urine, and of sa- 
liva." pp. xx. xxi. 

The symptoms or phenomena of cholera, however, 
are liable to variation. In some, vomiting is slight, or 
soon ceases, or is altogether absent ; and the substan- 
ces ejected may vary, being sometimes bilious, in 
other instances, thin watery fluid. Purging is more 
constant, and is rarely altogether absent ; but the 



68 HISTORY OF THE 

matters discharged are liable to extreme variety. 
After the first emptying of the bowels, they have been 
observed to be greenish, or yellowish, turbid, frothy 
like yeast, and sometimes bloody, or even pure bile. 
In some cases they are inodorous, in others, they 
have a rank fleshy smell. But by far the most com- 
mon is that of pure serum, so thin and colorless as 
not to stain the patient's linen ; next is the conjee-like 
fluid, the mucus, however, being always so thorough- 
ly mixed with serum as to give the whole the appear- 
ance of milk ; and in cases which proved to be mild, 
the matters discharged resembled soojee in color and 
consistence. The quantity of clear watery fluid dis- 
charged is sometimes very great ; and if it w r ere uni- 
form, the reporter remarks, it would readily explain 
the weakness, thirst, thickness of the blood, and oth- 
er symptoms ; but it is unquestionable, that the most 
fatal and rapid cases are by no means those which 
are distinguished by excessive discharges. The de- 
jections sometimes take place without effort or unea- 
siness, at others they are discharged with great force, 
in general, simultaneously, with vomiting, spasm, and 
stoppage of the pulse, — seldom attended with much 
griping or tenesmus, though the calls are sudden and 
irresistible. Pain of the belly, felt on pressure, is on- 
ly occasionally remarked. 

Of the phenomena referred to spasms, we find the 
following account : — 

" In the low, and most dangerous, form of cholera, 
whether in European or native cases, spasm is gen- 
erally wanting, or is present in a very slight degree. 
The muscles most commonly affected are those of the 
toes and feet, and calves of the leg ; next to them, 
the corresponding muscles of the superior extremities \ 



SYMPTOMS OF CHOLERA. 69 

then those of the thighs and arms ; and lastly, those 
of the trunk, producing various distressing sensations 
to the patient. Amongst these, hiccup is not unfre* 
quent, but it has been observed that this symptom, 
in cholera, is not at all indicative of danger. The 
muscles of the eye- balls have not been observed to 
be affected with spasm, unless the sinking of these or- 
gans in their orbits may be considered to be an effect 
of it. The reports make frequent mention of a re- 
markable permanent contraction of the muscles pf the 
abdomen, by which the belly is drawn towards the 
spine. The spasms attending cholera are of a mix- 
ed nature, not strictly clonic ; the relaxations being 
less prompt and frequent than in epilepsy or convul- 
sion, and seldom durable as in tetanus. The con- 
tractions of the muscles are invariably attended with 
pain, and some medical officers have observed, that a 
degree of spasmodic stiffness has continued for seve- 
ral days afterwards. It has also been remarked, that 
spasmodic twitchings of the muscles have taken place 
after death, and have continued for a considerable 
time. In one case, where a man had been paralytic 
in his limbs, with a total numbness of them, they 
were severly affected with spasms, and became ex-, 
quisitely sensible. If was pretty evident, that there 
either has been an inaccuracy in the description of 
spasm occurring incases of cholera, or a sensation 
differing from that of spasm has been confounded with 
it ; for, by the descriptions, we would be led to sup- 
pose that the spasms begin, and are felt, in the toes 
and fingers, which cannot be the case. As the ex- 
treme muscles, however, are generally first seized 
with spasm, it is probable that the small fleshy bun- 
dles in the palms of the hands and soles of the feet, 



70 HISTORY OF THE 

are affected ; but there seems reason farther to con- 
clude, that pain is really felt in the fingers and toes, 
and that it is referable to a sort of nervous twinge o^ 
tic doloureux in those parts, distinct from spasm, 
which is not uncommon in other disordered states of 
the digestive organs." — Report, pp. xxiv. xxv. 

The following observations on the assemblage of 
phenomena, to which the East Indian practitioners 
give the name of Collapse, are very interesting. 

" Of all the symptoms of Cholera, none is so inva- 
riably present, none indeed so truly essential and di- 
agnostic, as the immediate sinking of the circulation. 
It must nevertheless be admitted, that, where instant 
remedial measures have been successfully practised, 
this symptom may not have developed itself; and 
that there are even cases where an excited vascular 
action has been observed to accompany the first 
movements of the system in cholera. Some intelli- 
gent practitioners have entertained doubts whether 
such cases belong indeed to this disease ; and there 
seems reason to imagine that those inflammatory af- 
fections with spasm, known in this country, and al- 
luded to in several reports, may, in some instances, 
have been mistaken for it. It is farther to be remem- 
bered, that these are precisely the cases w 7 hich yield 
most certainly and readily to our remedial means : 
and it consequently follows, that a medical man can 
seldom have the opportunity of observing whether or 
not this form of cholera will degenerate into the low 
stage. There is, however, direct evidence in support 
of the fact, that they have so degenerated and gone 
on to a fatal termination. In the case of soldiers too, 
in whom such symptoms have chiefly appeared, we 
must make some account of the quantity of spirits 



SYMPTOMS OF CHOLERA. 71 

usually drank by them at the commencement of the 
disease, producing ah effect on the circulation. The 
period at which a marked diminution of vascular ac- 
tion takes place, is somewhat various. The pulse 
sometimes keeps dp tolerably for several hours, though 
very rarely. It more generally becomes small and 
accelerated at an early stage •, and, on the accession 
of spasm, or vomiting, suddenly ceases to be distin- 
guishable in the extremities. The length of time du- 
ring which a patient will sometimes live in a pulse- 
less state, is extraordinary. Dr. Kellett relates a case, 
where the pulse wasgone within three hours from the 
attack ; yet the man lived in that state from the 3d Oct. 
at 4 P. M., to the 6th at 2 P. M. On the cessation of 
the spasm or vomiting, and sometimes, apparently, 
from the exhibition of remedies, the pulse will return 
to the extremities for a short time, and again it will 
cease. The superficial veins and arteries are not al- 
ways collapsed, even when the pulse has ceased. If 
these vessels be opened in this condition, the contain- 
ed blood flows out •, their walls then collapse, and no 
more blood can be extracted. There is no authenti- 
cated fatal instance of cholera on record, where the cir- 
culation has not been arrested, in the extremities at 
least, long before death took place." Report, p. xxv. 
The reporter proceeds to describe, in a minute, but 
instructive manner, the various forms assumed by 
such symptoms as thirst, sense of heat in the epigas- 
trium, and internal burning in general ; (he temper- 
ature, shrinking and insensibility of the skin to its or- 
dinary irritants ; the shrinking of the countenance; 
the changes which respiration undergoes, especially 
in becoming much slower, less frequent, and more 
lat>orious than during health ; the occurrence of the 



32 HISTORY OF THE 

state termed jactitation; the comparative clearness 
and integrity of the intellectual faculties ; the state of 
the urine and the state of the blood. Of his observa- 
tions on each of these, we can make room only for 
those relating to the state of the skin and that of the 
blood, which form features of the morbid process of 
cholera so characteristic, that they deserve to be gen- 
erally known. 

" The state of the skin in cholera is, in general, 
what we might expect to find it in patients laboring 
under such affections of the alimentary canal, and 
with the subdued circulation which takes place in 
that disease. It is cold, generally clammy, and 
often covered with profuse cold sweats. Neverthe- 
less, varieties occur in this, as in the other symptoms 
of cholera. The skin is sometimes observed to be 
dry, though cold ; and sometimes natural, nay, in 
some rare instances, of preternatural warmth. An in- 
crease of temperature has been repeatedly observed 
to take place just before death : but the development 
of heat appears to be confined then to the trunk and 
head; and, in almost all cases, this partial develop- 
ment of heat is found to be a fatal symptom. It is 
entirely unconnected with any restoration of the en- 
ergy of the arterial system, or any improvement in the 
function of respiration. The heat, in such instances, 
has been observed to continue considerable, for some 
hours after death. 

" The sensation imparted by touching the skin of a 
person ill with cholera is very peculiar, and reminds 
one of that imparted by a dead body. The skin, 
when much collapsed, becomes insensible, even to 
the action of chemical agents; and hence the usual 
vesicatories fail in producing any effect. The appli- 



SYMPTOMS OF CHOLERA. 73 

cation of mineral acids, and of boiling water, in this 
condition of the skin, produces little or no effect, and 
some patients are said not to have been sensible of 
the operation. 

" The action of mineral acids on the skin, is not, 
however, vesication, but rather that of a cautery, the 
cuticle and the extremities of 1 he subjacent vessels 
appearing to be destroyed by thorn. It has been said, 
that vesication could not be p roduced in some sta- 
ges of cholera, because the pro/ Auction of serum was, 
in common with the glandular secretions, arrested ; 
but when we reflect on the readiness with which se- 
rous fluids are poured out in that disease, we shall be 
rather disposed to refer the faih .re in the action of 
vesicatories, even of hot water, t< the diminution or 
destruction of the nervous energy of the skin. It is 
certain, that in a body but just dead, the application 
of boiling water will vesicate readily ; and, if the ac- 
curacy of the observation respecting its non-vesica- 
ting power in advanced stages of cholera be establish- 
ed, we must infer that there is less vitality in the skin 
in such cases, the patient being sti.U alive, than in 
that of a body recently dead of some other disease." 
Report, pp. xxvi. xxvii. 

It is also remarked, that, at an early period of the 
disease, leeches can procure no blood from the skin. 

On the state of the blood and its circulation, we 
are informed that " though the reports afforded ample 
reference on the subject, yet it appeared to the Medi- 
cal Board, to be one of such importance in the pathol- 
ogy of the disease, that a circular letter was address- 
ed to about thirty Medical Officers, who were sup- 
posed, from their experience in the treatment of it, to 
be best qualified to afford information. Attention 



74 HISTORY OF THE 

was especially directed to the following considera- 
tions : first, the influence .which the state of the blood 
in those affected with cholera, might be supposed to 
have in producing some of the symptoms : second, the 
color of the blood abstracted from a vein, in a person 
affected with cholera : third, the color of the blood 
after a certain quantity had been taken, and, the ef- 
fect which any alteration of color might have on the 
condition of the patient : fourth, if arteriotomy had 
been practised, the color of the arterial blood in chol- 
era : and lastly, the period from the first attack of the 
disease, at which blood was abstracted. It is estab- 
lished by the replies to this letter, as well as by an im- 
mense mass of concurrent evidence, that the blood oi 
persons affected with cholera,isof an unnaturally dark 
color and thick consistence. These appearances are 
very uniformly expressed by the terms dark, black, 
tarry, in regard to color ; and by thick, ropy, syrupy, 
semicoagulated, in respect to its consistence. The 
change in the condition of the blood is likewise fully 
proved to be in the ratio of the duration of the disease ; 
the blood at the commencement, seeming to be near- 
ly, or altogether natural, and more or less rapidly as- 
suming a morbid state, as the disease advances. 
Some very rare cases are recorded where, however, 
this morbid state of the blood was not observable, al- 
though the disease had been for some time establish- 
ed ; and instances have occurred where the blood 
flowed readily, sometimes little altered, where, never- 
theless, death ultimately ensued. The abstraction 
of blood has been found by all practitioners, to be 
very difficult and uncertain ; and the uncertainty has 
been variously imputed to the feebleness of the circu- 
lation, to the thick consistence of the blood, and to 



SYMPTOMS OF CHOLERA. 75 

the combined operation of these causes. The blood 
drawn from patients suffering under cholera, is stated 
to be generally very destitute of serum, never to exhi- 
bit the appearance of buff, and to be generally dis- 
posed to coagulate quickly. Several instances, how- 
ever, have occurred, where the coagulation was slow 
and imperfect. A great majority of the reports state 
unequivocally, that, after a certain quantity of dark 
and thick blood has been abstracted from a patient 
under cholera, it is usual for its color to become 
lighter, its consistence to become less thick, and for 
the circulation to revive ; such appearances always 
affording grounds for a proportionably favorable prog- 
nosis. In many instances, however, no such changes 
have been observed to accompany the operation of 
bleeding, while jet the result was favorable. The 
blood is generally found to be less changed in appear- 
ance, in those cases of cholera which are ushered in 
with symptoms of excitement, than where the col- 
lapsed state of the system has occurred at an early 
period. The blood has been occasionally found, on 
dissection, to be of as dark a color in the lefU as in the 
right side of the heart ; affording reason to believe that 
in the whole arterial system it was equally changed. 
The temporal artery having been frequently opened, 
the blood was found to be dark and thick, like the 
venous blood : but it would appear that this opera- 
tion has not been performed in general, until the at- 
tempts to procure blood from the brachial or jugular 
yeins had failed : little or no blood could be obtained, 
the artery merely emptying itself in a languid stream, 
not in a jet, and then collapsing. An instance is sta- 
ted where the surgeon, despairing of other means, cut 
down upon the brachial artery, but so completely had 



76 HISTORY OF THE 

the circulation failed, that no blood flowed. When 
reaction has been established, the blood occasionally 
shows the buffy coat." pp. xxix. xxx. 



SYMPTOMS OF THE CHOLERA IN EUROPE. 

The symptoms which this disease manifested in 
Russia and other parts of Europe, several years af- 
ter the foregoing account of the disease, as it was no- 
ticed in India, was written, are strikingly similar, 
as is evident from the following accounts of the dis- 
ease; selected from various authorities, who were eye 
witnesses. 

Drs. Russell and Barry, in a joint report made to 
the British Government respecting the disease as it 
appeared in Russia, say, — 

" St. Petersburgh, July 27, 1831. 

Although there can be no doubt that the disease 
now prevailing here is strictly identical, in all essen- 
tial points, with the epidemic cholera of India ; and 
although there are many descriptions extant of that 
malady, much more ably and accurately drawn up 
than any which we can pretend to give 5 yet we are 
induced to believe that a short account of the symp- 
toms which we ourselves have actually witnessed 
and noted at the bedside in some hundreds of cases, , 
since our arrival here, may be useful, — first, because 
we are not aware that any description by an eye wit- 
ness of European cholera has yet been addressed to 
the British Government ; secondly, because the dis- 
ease, as it has shown itself in this capital, when closer 
ly compared with the Indian cholera, appears to have 
undergone some modifications 5 thirdly, because. 



SYMPTOMS OF CHOLERA IN EUROPE. 77 

having now studied the disease in all its stages, our 
description, however imperfect, will at least assist 
towards establishing a standard of comparison with 
other local epidemics of cholera in Europe, and may, 
perhaps, enable those who have not seen this disease, 
to recognise it with more certainty than they would 
otherwise be able to do. 

The cholera morbus of the north of Europe, to 
which the Russian peasants have given the name of 
4 Chornaia Colezn,' or black illness^ like most other 
diseases, is accompanied by a set of symptoms which 
may be termed preliminary ; by another set which 
strongly mark the disease in its first, cold, or collapse 
stage ; and by a third set, which characterizes the 
second stage, that of re-action, heat, and fever. 

Preliminary Symptoms. — We have but few oppor- 
tunities of witnessing the presence of all these symp- 
toms, some of which precede the complete seizure 
by so short an interval, that the utmost diligence is 
scarcely sufficient to bring the patient and the physi- 
cian together, after their occurrence, before the dis- 
ease is fully formed. Diarrhea, at first feculent, with 
slight cramps in the legs, nausea, pain, or heat about 
the pit of the stomach, malaise, give the longest warn- 
ing. Indeed, purging, or ordinary diarrhea, has been 
frequently known to continue for one, two, or more 
days, unaccompanied by any other remarkable symp- 
tom, until the patient is suddenly struck blue, and 
nearly lifeless. Often, the symptoms just mentioned 
are arrested by timely judicious treatment, and the 
disease completely averted. When violent vertigo, 
sick stomach, nervous agitation, intermittent, slow T ,or 
small pulse, cramps, beginning at the tips of the fin- 
gers and toes, and rapidly approaching the trunk, give 

7* 



78 History of the 

the first warning ; then there is scarcely an interval. 
Vomiting or purgirig, or both these evacuations, of a 
liquid like rice-water, or whey, or barley-water, 
come on ; the features become sharp and contracted, 
the eye sinks, the look is expressive of terror, wild- 
ness, and, as it were, a consciousness on the part of 
the sufferer that the hand of death is upon him. The 
lips, the face, the neck, the hands, the feet, and soon 
the thighs, arms, and whole surface, assume a lead- 
en, blue, purple, black, or deep brown tint, according 
to the complexion of the individual, varying in shade 
with the intensity of the attack. The fingers and 
toes are reduced at least a third in thickness ; the 
skin and soft parts covering them are wrinkled, shriv- 
elled, and folded ; the nails put on a bluish pearl- 
white, the larger superficial veins are marked by flat 
lines of a deeper black ; the pulse is either small as 
a thread, and scarcely vibrating, or else totally ex- 
tinct. The skin is deadly cold, and often damp ; the 
tongue always moist, often white and loaded, but flab- 
by and chilled, like a bit of dead flesh. The voice is 
nearly gone ; the respiration quick, irregular, and 
imperfectly performed. Inspiration appears to be 
effected by an immense effort of the chest, whilst the 
alse nasi (in the most hopeless cases, and towards 
their close), instead of expanding, collapse, and 
stop the ingress of the air. Expiration is quick and 
convulsive. The patient asks only for water, speaks 
in a plaintive whisper, (the ' vox cholerica,') and on- 
ly by a word at a time, from not being able to retain 
air enough in his lungs for a sentence. He tosses in- 
cessantly from side to side, and complains of intole- 
rable weight and anguish around his heart. He strug- 
gles for breath, and often lays his hand on his stom- 



SYMPTOMS OF CHOLERA IN EUROPE. 79 

ach and chest to point out the seat of his agony. The 
integuments of the belly are sometimes raised into 
high irregular folds, whilst the belly itself is violently 
drawn in, the diaphragm upwards and inwards to- 
wards the chest ; sometimes there are tetanic spasms 
of the legs, thighs, and loins ; but we have not seen 
general tetanus, nor even trismus. There is occa- 
sionally a low, suffering whine. The secretion of 
urine is always totally suspended, nor have we ob- 
served tears shed under these circumstances ; vomit- 
ing and purging, which are far from being the most 
important or dangerous symptoms, and which, in a 
very great number of cases of the present epidemic, 
have not been profuse, generally cease, or are arrest- 
ed by medicine easily in the attack. Frictions re- 
move the blue color for a time from the part rubbed ; 
but in other parts, particularly the face, the livor be- 
comes every moment more intense and more general. 
The lips and cheeks sometimes puff out and flap, in 
expiration, with a white froth between them, as in 
apoplexy. If blood be obtained in this state, it is 
black, flows by drops, is thick, and feels to the finger 
colder than natural. Towards the close of this scene, 
the respiration becomes very slow, there is a quiver- 
ing among the tendons of the wrist, the mind remains 
entire. The patient is first unable to swallow, then 
becomes insensible ; there never is, however, any 
rattle in the throat, and he dies quietly after a long 
convulsive sob or two. 

The above is a faint description of the very worst 
kind of case, dying in the cold stage, in from six to 
twenty four hours after the setting in of the bad symp- 
toms. We have seen many such cases just carried 
to the hospital from their homes or their barracks. 



SO HISTORY OF THE 

In by far the greater number, vomiting had ceased, 
in some, however, it was still going on, and invariably 
of the true serous kind. Many confessed that they 
had concealed a diarrhea for a day or two 5 others 
had been suddenly seized, generally very early in 
the morning. 

From the aggravated state which we have just de- 
scribed, but very few indeed recover, particularly if 
that state has been present even for four hours before 
treatment has commenced. A thread of pulse, how- 
ever small, is almost always felt at the wrist, where 
recovery from the blue or cold stage is to be expect- 
ed. Singular enough to say, hiccough coming on in 
the intermediate moments, between the threatening 
of death and the beginning of re-action, is a favora- 
ble sign, and generally announces the return of circu- 
lation. 

In less severe cases, the pulse is not wholly extin- 
guished, though much reduced in volume ; the respi- 
ration is less embarrassed ; the oppression and an- 
guish at the chest are not so overwhelming, although 
vomiting and purging and the cramps may have been 
more intense. The coldness and change of color of 
the surface, the peculiar alteration of the voice, a 
greater or less degree of the coldness of the tongue, 
the character of the liquids evacuated, have been in- 
variably well marked in all the degrees of violence of 
attack which we have hitherto witnessed in this 
epidemic. In no case or stage of this disease have 
we observed shivering ; nor have we heard, af- 
ter inquiry, of more than one case, in w T hich this feb- 
rile symptom took place. 

Fever or Hot Stage. — After the blue "cold period 
has lasted from twelve to twenty-four, seldom to for- 



SYMPTOMS OF CHOLERA IN EUROPE. 81 

ty-eight hours or upwards, the pulse and external 
heat begin gradually to return, head-achis complain- 
ed of, with noise in the ears, the tongue becomes more 
loaded, redder at the tip and edges, and also drier. 
High colored urine is passed with pain, and in small 
quantities, the pupil is often dilated, soreness is felt on 
pressure over the liver, stomach, and belly, bleeding 
by the lancet or leeches is required. Ice to the head 
gives great relief. In short, the patient is now labor- 
ing under a continued fever, not to be distinguished 
from ordinary fever. A profuse critical perspiration 
may come on, from the second or third day, and leave 
the sufferer convalescent ; but, much more frequent- 
ly, the quickness of pulse and heat of skin continue, 
the tongue becomes brown and parched, the eyes 
suffused and drowsy, there is a dull flush, with stupor 
and heaviness about the countenance, much resem- 
bling typhus, dark sordes collect about the lips and 
teeth, sometimes the patient is pale, squalid, and low 7 , 
with the pulse and heat below natural, but with the 
typhus stupor, delirium supervenes, and death takes 
place from the fourth to the eighth day, or even later, 
in the very individual, too, whom the most assiduous 
attention had barely saved in the first or cold stage. 
To give a notion of the importance and danger of 
cholera fever, a most intelligent physician, Dr. Rei- 
mer, of the merchant hospital, informs us, that of 
twenty cases treated under his own eye, who fell vic- 
tims to the disease, seven died in the cold stage, and 
thirteen in the consecutive fever. 

The singular malady is only cognizable witli cer- 
tainty during its blue or bold period. After re-action 
has been established, it cannot be distinguished from 
an ordinary continued fever, except by the shortness 



82 HISTORY OF THE 

and fatality of its course. The greenish or dark, and 
highly bilious discharges produced in the hot stage, by 
calomel, are not sufficiently diagnostic, arid it is curi- 
ous that the persons employed about these typhoid 
cases, when they are attacked, are never seized with 
ordinary fever, but with a genuine cold, blue cholera; 
nothing, therefore, is more certain, than that persons 
may come to the coast of England, apparently labor- 
ing under common feverish indisposition, who really 
and truly are suffering under cholera in the second 
stage. 

The points of difference between the present epi- 
demic and the cholera of India, when the two diseas- 
es are closely compared, appear to us to be the follow T - 
ing :— 

First, The evacuations, both upwards and down- 
wards, seem to have been much more profuse and un- 
governable in the Indian, than in the present cholera, 
though the characters of the evacuations are precise- 
ly the same. 

Secondly, Restoration to health from the cold 
stage, without passing through consecutive fever of 
any kind, was by far more frequent in India than 
here, nor did the consecutive fever there assume a 
typhoid type. 

Thirdly, The proportion of deaths in the cold 
stage, compared with those in the hot, was far greater 
in India, according to Dr. Russell's experience, than 
here. 

Fourthly, The number of medical men and hospi- 
tal attendants, attacked with cholera during the 
present epidemic, in proportion to the whole employ- 
ed, and to the other classes of society, has been be- 
yond all comparison greater here, than in India under 






SYMPTOMS OF CHOLERA IN EUROPE. 83 

similar circumstances ; twenty -five medical men 
have been already seized, and nine have died out of 
two hundred and sixty-four. Four others have died 
at Cronstadt, out of a very small number residing in 
that fortress, at the time the disease broke out there. 
Six attendants have been taken ill at a small tempo- 
rary hospital behind the Aboucoff, since we wrote 
last. It is certain, however, that in some cholera 
hospitals, favorably circumstanced as to size, ventila- 
tion, and space, very few of the attendants have suf- 
fered.' 

Of these facts we are likely to receive accurate 
statements, in answer to the written questions which 
we have submitted to the medical authorities through 
the Government here. 

Convalescence from cholera has been rapid and 
perfect here, as is proved by the following fact. The 
Minister of the Interior had given orders that all con- 
valescents, civil as well as military, at the General 
Hospital, should be detained fourteen days. We in- 
spected about two hundred of these detenus some days 
back, with Sir James Wylie, and found them in ex- 
cellent health, without a single morbid sequela a- 
mongst them. 

Relapses are rare in this epidemic, nor have they 
been often attended with fatal results ; hospital ser- 
vants seem to have been most liable to them. One 
physician had three attacks, the second severe, in 
which he states that he derived great benefit from the 
Magisterium bismuthi." 

Sir William Crichton, physician in ordinary to the 
Emperor of Russia, in a memorial presented to the 
medical council of St. Petersburg, says the symp- 
toms of the cholera at Moscow were " General unea 



84 HISTORY OF THE 

siness ; violent headache and giddiness •, great lan- 
guor ; oppression at the chest ; pain at the pit of the 
stomach and at the sides ; a very weak pulse, and fre- 
quent vomitings, first of undigested food, and then of a 
watery fluid mixed with phlegm 5 frequent purging ; 
severe pains, which make the patient roll about and 
scream ; cessation, or very scanty secretion of urine ; 
excessive thirst ; cramp in the legs, beginning at the 
toes, and by degrees reaching the body ; voice feeble 
and hoarse; the eyes dull and sunk in the head 5 the 
features changed, and like those of a corpse J cold- 
ness \ contraction and blueish tinge of the extremi- 
ties ; a coldness over the whole body ; the lips and 
tongue become blue 5 a cold and clammy perspira- 
tion. The vomiting and purging soon exhaust the 
strength of the patient. The spasms become greater, 
attacking, successively, the most vital parts. The 
pulse ceases, the beating of the breast becomes 
scarcely sensible, and the patient, after having suf- 
fered the most horrible martyrdom, dies quietly, hav- 
ing a few minutes ease just before his end. The du- 
ration of the malady is, generally speaking, from 
twenty-four to twenty-eight hours; but sometimes 
its course is still more rapid, and sometimes slower." 

The symptoms of the cholera in England are thuF, 
described in the Medico-Chirurgical Review fq»r 
April, 1832. 

" The cholera in England has maintained a striking 
resemblance to the oft repeated descriptions of its 
symptoms in other countries. Thus, the severe vom- 
iting and purging of peculiar characteristic secretions ; 
the nausea, internal burning at the epigastrium, intol- 
erable weight, anguish, and oppression ; the parox- 
ysms of severe pain commencing at the stomach, and 



SYMPTOMS OF CHOLERA IN EUROPE. 85 

rapidly extending over the whole alimentary canal ; 
the ardent thirst; the cramps ; the deadly prostra- 
tion, anxiety, and dejection ; the conscious feeling of 
the hand of death ; the failing of the circulation and 
animal heat ; the peculiar cold sweat 5 shrinking of 
the skin and subjacent tissues; sharpening of the fea- 
tures ; contraction of the fingers, and prominence of 
the tendons ; the hollow, sunken eye ; the leaden as- 
pect of the surface, particularly visible in the hands, 
feet, nails, lips, and the circles around the mouth and 
eyes ; the black, thick blood, often not to be obtained ; 
the difficult and slow respiration ; cold breath and 
tongue ; the whispering voice, and if death comes 
not in this shape, the fever rapidly coming on, often 
takes the last stage of typhus. The sudden invasion, 
speedy death, or, as rapid recovery, have all been 
witnessed in England, as well as in the north of Rus- 
sia, and on the banks of the Ganges. 

But this alarming catalogue, drawn up from the 
whole, presents no current picture of any individual 
case. These different symptoms in different persons 
vary infinitely in the degree of their severity, from the 
common diarrhea, with little pains and no cramps, 
and no greater affection of the circulation and tem- 
perature of the surface, than occurs from the opera- 
tion of an ordinary purgative, up to the sudden attack 
of a prostration so alarming, that the sick man 
becomes scarcely sensible of pain when the secre- 
tions are retained, and the heart's action sinks at once. 

To illustrate these different forms, we have made 
the following selection of cases. 

The following bears a greater resemblance to cook 
! mon cholera, than to the severer cases of the present 

epidemic. 

8 



86 HISTORY OF THE 

Mr. A. Hopton, Deputy Governor of the Goal at 
Durham, age 58, of rather free habits 5 general health 
not very good. On the 14th of January, he felt op- 
pression at the stomach, sense of heat and uneasiness, 
with occasional nausea. At two o'clock on the 
morning of the following day, he was seized with vi- 
olent purging, attended with most distressing cramps 
in the limbs : the evacuations were almost incessant 
throughout the day ; thin and watery, of a pale white 
color, almost without smell ; at eight in the evening, 
there was great alteration in his appearance ; coun- 
tenance blanched and anxious 5 features sharp ; skin 
rather cold, and covered with a clammy sweat ; 
pulse slow and weak ; breathing oppressed ; com- 
plains of most distressing thirst, some softening of cu- 
ticle of fingers 5 the cramps are not constant, but re- 
cur at intervals ; most violent in the hands and feet ; 
occasionally extending to the thigh 5 inclined to sleep 
in the intervals. 

Treatment. Coffee, mustard, brandy, opium, cay- 
enne pepper, camphor, carb. ammonia, and oil of 
peppermint. The symptoms continued somewhat 
mitigated on this day and the following. 

The premonitory symptoms have been, in some 
cases, of long duration ; in others absent. They are 
uneasiness ; a sense of heat and disorder in the stom- 
ach and bowels ; frequently diarrhea, which at first 
presents no peculiar character, so that no man could 
tell whether an attack of the cholera was impending 
or not ; this has prevailed, in some cases, for a week 
or more before the attack, in others, it has only pre- 
ceded the other symptoms for a few hours, or a short- 
er period. 

The elder Sproat, aged 69, the first case of acknowl- 



SYMPTOMS OF CHOLERA IN EUROPE. 87 

edged cholera in Sunderland, had been laboring un- 
der diarrhea a week or ten days before his seizure. 
On Wednesday, Oct. 19th, he had been taken worse : 
on Thursday and Friday, he had vomiting and pur- 
ging of feculent matter, but no symptoms of collapse. 
On Saturday he was greatly better, took a mutton 
chop to his dinner, and went out to his keel in the 
afternoon. In about 20 minutes he returned, and 
was taken very ill, with severe shivering, giddiness, 
cramp at the stomach, violent vomiting and purging. 
On Sunday morning he was sinking 5 pulse impercep- 
tible ; extremities cold ; skin dry ; eyes sunk ; lips 
blue ; features shrunk ; whispering voice 5 violent 
vomiting and purging ; cramp of the calves of the 
legs, and complete prostration. In the afternoon his 
skin became warmer, but the other symptoms contin- 
ued. On the 24th he was quite collapsed, with ag- 
gravation of all the symptoms, except the vomiting, 
which had entirely ceased ; stools passed involunta- 
rily. On the following morning he was less collapsed ; 
countenance more natural ; blueness of the lips had 
disappeared ; the vomiting had ceased ; but the pur- 
ging still continued less violent, and nearly impercep- 
tible 5 extremities cold ; spasms of the legs continued. 
Towards evening, the purging and vomiting had en^- 
tirely ceased : he became sleepy ; the other symp- 
toms continuing. On the morning of the 26th he was 
much weaker ; pulse scarcely perceptible ; counte- 
nance quite shrunk ; eyes sunk ; lips blue, as well as 
the lower extremities ; the nails were livid. He was 
comatose, and died at 12 at noon. 

2. Premonitory Symptoms slight*, and of very short 
duration. 

Susanna Clark, aged 18. December 5th, about 5 



88 HISTORY OF THE 

in the evening, she complained of uneasiness and dis- 
tension of the stomach and bowels 5 her countenance 
became pallid, and expressive of much anxiety and 
distress. She was attacked with vomiting and pur- 
ging of bilious fluids, and with cramps. She contin- 
ued in this state until 8 in the evening, when bleed- 
ing was unsuccessfully attempted. She took brandy, 
and a mixture containing laudanum, capsicum, and 
ammonia. The vomiting ceased, she became much 
better in the night, and, on the morning of the 6th, 
her pulse was full and her body warm, complaining of 
little except a pain in the head : but, about midnight, 
the cramps, vomiting, and purging returned ; she 
became cold, and apparently almost lifeless, though 
still sensible. Her pulse was gone ; her eyes deeply 
sunk ; she remained in the same state through the 
day, until 6 at night, when she became comatose, 
and died at 8." 

Dr. Lawrie, Professor of Surgery, Andersonian 
University, thus describes the disease as it appeared 
at Sunderland, Newcastle, Gateshead, &c. 

He divides the malignant cholera, as it appeared 
at these places, into five stages. 1. Premonitory: 
2. The acute: 3. The collapsed: 4. The rallying: 
5. The febrile. 

" The premonitory consists essentially of diarrhea, 
with a slight degree of the cold stage, malaise, and 
perhaps spasmodic twitchings of the limbs. This 
stage varies from a very few hours to two, four, or 
even six days. The acute stage is always rapid, 
though varying in its symptoms. In some, it con- 
sists of a very sudden increase of the preceding 
symptoms, and the stage of collapse speedily super- 



SYMPTOMS OE CHOLERA IN EUROPE. gy 

venes. In others, there is vomiting as well as purg- 
ing acute spasms, thirst, often acute spasm at the pit 
ot the stomach, and almost constantly a burning un- 
quenchable, gnawing sensation ; the pulse continues 
good, and the surface is not very cold. The face 
becomes more sunken and anxious, and the patient 
is very restless. Respiration is rather slow, the se- 
cretions are diminished, that of the urine suspended, 
tne skin clammy, sometimes perspiring profusely,- the 
voice husky. A vein opened yields blood freely. 
Um stage may be very short, or some hours may 
elapse before collapse be fairly established. In some 
instances, the attack is instantaneous, the patient 
falling senseless, and recovering to be plunged into 
more prolonged agony. The fact is, that the modes 
oi attack are various, and the symptoms differ in dif- 
ferent cases." 

"The majority of medical men affirm that the 
mmd is always unimpaired. I can only say that it 
appeared to me in many cases affected, to a degree 
little short of what we find it in concussion of the 
brain, probably owing to congestion in the vessels of 
the head. I remarked this particularly in several 
children. When undisturbed, they lay in a dull 
sleepy, semi-comatose state, breathing with perfect 
calmness. When roused, they thought only of re- 
lieving their distressing sensations, and vociferated 
for cold water. I had at one time five of the same 
family in one bed, all calling loudly fcr fluid to allay 
their ■burning thirst. So urgent were they, that they 
could be bribed to swallow any medicine, by the 
promise of a mouthful of cold water. When appeas- 
ed, they relapsed into their previous sleepy condi- 
tion. 

8* 



90 HISTORY OF THE 

" It is hardly necessary to say, that confirmed col- 
lapse is a state of extreme danger, and that it is it 
which destroys the vast majority of cholera patients. 
The cause of death, in many cases, is a failure of the 
functions of animal life alone ; in others, affection of 
the brain, induced either by venous congestion or the 
absence of arterial blood, hastens the fatal termina- 
tion. 

I am borne out in this last view of the cause of 
death, by the fact, that, although the powers of ani- 
mal life are first affected, they are in some cases 
the last destroyed. Convulsive movements are com- 
mon after mental life is quite extinct; and, as I for- 
merly remarked, it is almost impossible to say at 
what moment the vital motions have ceased to vi- 
brate; A body lies apparently lifeless ; suddenly a 
convulsive shudder shakes it ; its hands are clench- 
ed, if you put your own within them, and force them 
open, they shut again with a spasmodic catch. It is 
not to be wondered at if these appearances have a 
powerful effect on the superstitious feelings of the un- 
educated, and make them averse to very early inter- 
ments.' 

" The 4th stage is that of rallying. Sometimes, but 
these are the exceptions, it is complete and rapid ; 
usually it is of some hours' duration, nay, even of two 
or three days, and the animal powers seemed placed 
in a delicate balance. In some of the most rapidly 
fatal cases, Dr. L. had seen the heat partially return 
to the surface, the pulse flicker^ and sensation slight- 
ly restored, immediately before death. 

' 5th. Febrile Stage. A patient who has entered 
the stage of collapse, is rarely restored to health, with- 
out passing through a fever closely resembling ty- 



SYMPTOMS OF CHOLERA IN EUROPE. 91 

phus. My residence in Newcastle was too short to 
enable me to say from personal observation, what is 
its usual duration, but I understood that it varied from 
seven to fourteen days. The ordinary cases present 
no peculiarity of symptoms, which could distinguish 
them from those of common continued fever. At first I 
thought the tongue cleaner, and the pulse less rapid ; 
but more extended observation showed, that these, 
especially the clean reddish tongue, are occasional, 
but by no means invariable symptoms. 

Congestion of particular organs is met with at the 
commencement or during the progress of the febrile 
stage. By far the most common is that of the vessels 
of the brain, marked by apathy, listlessness, dilata- 
tion of the pupils, suffused eyeballs, low muttering 
delirium, or total insensibility. The fauces, in some 
cases, in which the voice had been much affected, 
inflamed and suppurated. Inflammation of the brain 
followed one case of inflamed throat. The chest I 
rarely found affected. The respiration in the febrile 
stage is usually healthy, and the lungs free from con- 
gestion. I do not pretend to say that affections of 
the chest have no place among the sequelae of chole- 
ra, but that I have not met with them. > 

Congestions and inflammatory affections of the 
abdominal viscera are very frequent ; indeed it sel- 
dom happens that the functions of these organs are 
speedily restored. Under proper treatment, the liver 
is not very obstinate. I thought affections of the 
stomach, probably its mucous surface, as indicated by 
troublesome retching and vomiting, and of the bow- 
els, in the shape of constipation, fulness, and pain on 
pressure, much more common. The secretion of 
urine is restored, the skin assumes its ordinary hue, 



92 HISTORY OF THE 

and attains a febrile heat. The recovery is progres- 
sive, as from continued fever.' 

" Dr. L. considers the disease to be the same as the 
Indian cholera, but characterised by certain pecu- 
liarities which he enumerates. 

' First, The premonitory stage occurs in a much 
larger proportion of cases in the English than in the 
Indian disease. In the latter it was the exception, 
in the former it is the general rule. 

Second, The febrile stage is incomparably more 
frequent. I have met with it in India, but it general- 
ly appeared to me to be connected with derange- 
ments of the abdominal viscera. In Sunderland and 
JN ewcastle the experience seems to be, that very few 
who have fairly entered the collapsed stage, escape 
the secondary fever. 

Third, I think the head is more frequently affected 
in the British disease than in the Indian — as indica- 
ted by greater mental oppression and insensibility 
during the collapse, and more congestion in the fe- 
brile stage. In this last particular, I believe I differ 
from some other observers. I speak, however of my 
own experience only. 

Fourth, My observations would lead me to say, 
that the frequent discoloration of the surface consti- 
tutes a fourth peculiarity. I neither met with it so 
frequently, nor to the same extent in India.'* 

Dr. James B. Kirk, in a communication to the 
Greenock Board of Health thus alludes to the Cholera 
Asphyxia, as he saw it at Musselburgh, Newcastle, 
and the infected districts in the north of England. 

" Let me now give you as short a description as I 

* See Medico-Chirurgical Review for 1832. 



SYMPTOMS OF CHOLERA IN EUROPE. 93 

can of the premonitory disease. The patient com- 
plains of lassitude ; he has frequently partial uneasi- 
ness in the region of the stomach, but this not to such a 
degree as to alarm him. He has frequent evacuations 
from the bowels— from two to a dozen times a day— 
not attended with much griping. His countenance 
is sharp and dark. He knows not of this symptom, 
and it is only recognizable to the eye of experience. 
Occasional nausea may oppress him ; but this is not 
a very common symptom. These symptoms may 
continue, varying in severity, from one to ten days, 
before the second stage of the disorder supervenes. 
The evacuations at the first, are generally of a dark 
brown or blackish hue. As the looseness continues 
they gradually become less and less of a natural ap- 
pearance, until they assume the consistence and as- 
pect of dirty water. Some headach, cramp of the 
fingers, toes, and abdomen, and almost always slight 
giddiness and rigging of the ears, accompany these 
symptoms. Sometimes an intervening two or three 
days of costiveness supervenes, which is followed 
again by the diarrhea, and in a few hours collapse 
supervenes, and in general, nausea and vomiting. 
The skilful practitioner will now give pills composed 
of aloes and calomel, or a pill composed of scammo- 
ny, calomel, and aloes. The bowels then in general 
act briskly. Continue the course for three days- 
keep the patient warm in bed — give him mild and 
gentle nourishment ; and, after an immense quantity 
of horribly offensive dejections, the patient is com- 
pletely recovered, and snatched from the jaws of 
the dreadful fate which awaited him. Some practi- 
tioners prescribe the mustard emetic in this state, 
small doses of calomel and ginger, and bleeding free- 



94 HISTORY OF THE 

ly 5 but I prefer, decidedly, and on experience, the 
purgative system. 

This is the stage to which I wish to reduce all our 
cases of cholera. If we get them in this stage we can 
cure them with as much certainty as I have indica- 
ted. The natural secretions can be speedily restored, 
and health to a certainty induced. In the hospital at I 
Gateshead, every attendant had the premonitory 
symptoms 5 but the skill of their scientific attendants 
was at hand. Medicines were duly and regularly 
prescribed, and not one of them took the extreme 
symptoms. This has been the case, too, with al- 
most all the medical strangers who have visited the 
disease, and almost all the practitioners of the district 
of Newcastle have had premonitory symptoms. If, 
after this warning, cholera should break forth, in any 
district to which it has been addressed, I hesitate not 
to say to the municipal authorities of that place, the 
blood of the sufferers will rise in judgment against the 
cruel apathy of those who ought to have been their 
guardians, natural protectors, and fathers. 

If your patient, in this stage, is very robust, you 
must take blood to subdue irritation and high action ; 
but this will be very seldom necessary, and must al- 
ways be taken with the finger on the pulse, so as 
never to induce faintness. The disease now advan- 
ces to another stage if it has been left unassisted. 
The cramps become stronger, and the sickness fre- 
quent and considerable. There is pain in the region 
of the stomach, and restlessness, and much thirst. 
The countenance is anxious, and the features sharper 
than natural. The evacuations become like barley 
gruel. Still, however, the pulse is not depressed, 
and in general, the patient can keep on foot. He is 



SYMPTOMS OF CHOLERA IN EUROPE. 95 

often harassed with fits of vomiting. In this stage, 
too, the patient begins to experience excessive cold- 
ness of the extremities, and even partial coldness of 
the trunk. In all stages of the disease, except the 
consecutive fever, the tongue is moist, and slightly, 
but not deeply furred. The practitioner in this stage 
must step in with calomel and opium, till the healthy 
secretions are restored — say two grains of the for- 
mer, and the fifth of a grain of the latter, continued 
according to circumstances. If the discharges are 
very violent, the quantity of opium maybe increased 
to the fourth, the third and the half of a grain. Keep 
the patient warm in blankets — keep his arms and 
legs in strong worsted stockings. Appy heat to all 
parts of his body, by tins and bricks, and sand-bags ; 
and in eight cases out of ten, the disease will not run 
into the stage of collapse. If the pulse will bear it 
do not hesitate to take a moderate bleeding, but not 
so free as in the last stage. I am aware that the 
common practice in this stage is to give, in the first 
place, a mustard emetic ; but I decidedly disapprove 
of it 5 for 1 have seen, in this stage, collapse most cer- 
tainly produced by the emetic. 1 am well aware of 
the partiality of many to this emetic, and of their re a- 
; sons ; but 1 must say that 1 disapprove of producing 
" vomiting, in all stages of the disease, except the bil- 
a ious stage of consecutive fever. I think it is apt to 
' depress the energy of the system still farther. You 
! will be told it gives an impulse to the system, and 
* that it produces bilious evacuations. This forced im- 
- r pulse is too often the precursor of the indirect debil- 
') ity it produces, and hastens collapse. I entertain, 
m however, the highest respect for the opinions of those 
( who still practice the mustard emetic 5 but I am bound 



96 HISTORY OF THE 

to declare my conviction, and I trust in stating my 
opinion, they will charitably give me that liberty they 
would take to themselves. 

The horrible symptom, collapse, comes next in or- 
der. It is characterized by pulselessness, coldness, 
loss of voice, terrible purging, and frequent vomiting, 
and a total cessation of the secretion of urine. Bleed- 
ing, and large opiates by the mouth, and stimulation 
by brandy, have been the practice in this stage ; but 
I have no hesitation in saying that large opiates are 
wrong; and that general bleeding, in general imprac- 
ticable, is often hurtful, and seldom useful. I dare 
not detain you in giving my reasons for this opinion ; 
but I have studied the subject with intense anxiety, 
and watched the practice in various hands, and I am 
bound to declare my conviction. 

The best practice is to give a large enema, of from 
three to four pounds, of as hot water as the hand can 
bear, with six ounces of brandy and two drachms of 
laudanum. After one hour, this enema should be 
withdrawn, by a tube introduced into the rectum. 
The enema is generally returned very cold, and an- 
other hot injection should then be thrown in. 

All the ordinary means of restoring heat should be 
studiously attended to : warm diluents frequently giv- 
en, with small portions of brandy. An insatiable 
thirst prevails, and the patient should be occasionally 
indulged in his anxiety for cold water. He is gene- 
rally denied it, but this is as cruel as it is unnecessary. 
I would certainly be careful of the quantity. I would 
withdraw this injection at the end of another hour, 
and then introduce an enema of a pound and a half 
of warm water, in which two drachms of common 
tobacco is infused. In nineteen cases which 1 have 



SYMPTOMS OF CHOLERA IN EUROPE. 97 

witnessed, pulsation and reaction have followed the 
use of the tobacco, and bilious evacuations and in- 
creased temperature. The action of vomiting has 
nothing to do with the result ; for in three cases which 
I witnessed, there was no vomiting after the exhibi- 
tion of the medicine. We are indebted for this prac- 
tice to an ingenious and most amiable gentleman, 
Mr. Baird, of Newcastle. If there is much pain of 
the bowels, particularly about the stomach, you can 
raise an instantaneous blister by applying to the 
stomach a cloth lifted out of boiling water, with great 
and immediate advantage. ] consider the vapor bath 
and air bath as very inefficient and trivial remedies ; 
but the hot tin mattress which is used in the Hospi- 
tals of Edinburgh, will be found the greatest improve- 
ment possible ; because it will heat the back, which 
was never effected by any other process before. 
Next to this, I prefer sand-bags to all other modes of 
giving heat. During the whole stage of collapse, I 
would recommend that from two to three grains of 
calomel be given every two hours; and if the cramps, 
pains, and sickness are severe, I would add to the 
calomel a quarter of a grain of opium. I would satis- 
fy the raging thirst; and, from its saline qualities, 
perhaps contribute to the melioration of the state of 
the blood, by giving every hour, or after every fit of 
vomiting, an effervescent draught, composed as fol- 
lows: Three drachms of super-carbonate of soda, 
dissolved in eight ounces of water; a dram-glassful 
j mixed with one table-spoonful of lemon juice, and a 
glass of water. This is an invaluable remedy, and 
should never be omitted. If you are fortunate enough 
to begin to see that the evacuations become feculent, 
then step in with full doses of calomel, with the addi- 



9 




98 HISTORY OF THE 

tion of jalap or rhubarb. If vomiting is a harassing 
symptom, cup the epigastrium, and add a few drops 
of laudanum to your effervescing draught. If the 
collapse is very complete, the actual cautery is some- 
times practised over the course of the spine ; from the 
accounts of my friends, and the three cases which I 
witnessed, 1 would think often with advantage. I 
cannot take leave of this stage without again most 
earnestly recommending the large hot injections. 

Blueness has been said generally to characterize 
this stage ; but in this country that is not the fact. 
The skin of the hands and face is brownish, not blue. 
If death is to ensue, there is a dreadful low wail of 
voice, which no man who has heard can ever forget. 
The lowest moan of the most wretched mendicant 
goes not to the heart so poignantly. A cold, clammy 
sweat breaks forth on all the surface ; the tempera- 
ture rises, and the pulse even becomes more percep- 
tible ; the dejections become frequent and severe ; 
and vomiting sometimes, though not always, is ex- 
cessive ; in a very short time the patient is a corpse. 
Sometimes, indeed, the vomiting and purging, and 
even the cramps cease In collapse, altogether ; and 
when the spasms cease. 1 have observed that the 
cases are always the most incurable. But if nature 
is to rally, the dejections become less frequent and 
more feculent ; the vomiting diminishes or ceases; 
the pulse gradually and steadily improves in fulness 
and in tone ; the voice becomes more powerful ; the 
strength improves, and the unfortunate is snatched 
from the dreadful fate that seemed to await him. 
But the horrors of this dreadful disease do not stop 
here. The system, by the peculiar poison producing 
this distemper, has been sunk into the lowest state of 



SYMPTOMS OF CHOLERA IN EUROPE. 99 

human existence. Those vessels which had ceased 
to beat, and all those muscular fibrils which have 
been for days convulsed and sealed up in spasm, can- 
not at once resume their healthy action. The vis 
medicalrix nature in resuming her play, seems over 
solicitous for the restoration of the functions ; and 
consequently she institutes an increased, and danger- 
ous action in every artery of the system. 

The tenderest and most important organs of the 
system, the brain, the lungs, and the liver, are now in 
imminent danger ; and the skill of the physician is 
called into play, not to be executed in stages and de- 
grees, but at once, promptly, and decidedly. Does 
congestive action manifest itself in the head, t le cup- 
ping glass or leeches should instantly be applie !, and 
vesication produced over the whole scalp in twenty 
minutes, by an application of a strong infusion of 
cantharides in the strongest acetic acid. The lancet 
must not now be spared, and drastic purgatives are to 
be freely administered. If the lungs are the seat of 
high action, indicated by oppression of breathing, 
sense of suffocation, full, large, and bounding pulse, 
and often spasm in the chest, bleed freely, and do not 
spare purgation ; and give 30 drops of wine of anti- 
mony every three hours. In bad cases, place the 
patient in a half-sitting posture. This practice is 
most important. 1 am indebted for this hint, to John 
Fyfe, Esq. of Newcastle, an excellent and eminent 
Surgeon, and I think, from positive experience, that 
it is a practice highly worthy of atterltion. A green- 
ish matter is now often largely discharged from the 
stomach, for which one or two emetics of common 
salt may be given with advantage. You must now 
attend carefully to^the state of the bladder, as now the 




100 HISTORY OF THE 

urine is secreted largely, and dangerous retention fre- 
quently takes place. The eminent Mr. Fyfe thinks 
that the duration of the consecutive fever is commen- 
surate with the duration and severity of the collapse ; 
and not much dependent on the kind of remedies em- 
ployed. This conclusion is doubtless generally cor- 
rect. But sometimes a very mild case precedes a 
dangerous fever \ and sometimes after the severest 
collapse, there is no fever at all. This fever, unless 
strictly watched, is more frequently fatal than collapse 
itself. After the purgatives 1 have recommended, 
three grains of calomel every four hours till the mouth 
is touched, is the best practice ; but it is difficult to 
touch the mouth. At the end of two days, the calo 
mel should be succeeded with mild aperients, castor 
oil, and laxative enemata. When the pulse rises 
under depletion, do not hesitate to repeat the bleeding 
boldly. Even three or four days after reaction, 
dreadful oppression of the brain frequently supervenes. 
This state should be treated exactly as we do Hy- 
drocephalus Acutus. I ought to remark that the 
consecutive fever always assumes the shape of Hy- 
drocephalus Acutus in infants, and should be treated 
accordingly. If recovery is effected from this conse- 
cutive fever, it is not uncommon that relapses more 
or less severe take place. These relapses take place 
as often after the mild, as after the severest form of 
the disease ; and may be generally traced to some 
imprudence in diet, or exposure to cold. We must 
treat them in the same mode as the original disease, 
diminishing the quantity of our doses." 

For the symptoms, &x. of the disease, as they ap- 



SYMPTOMS OF CHOLERA IN AMERICA. 101 

peared at Paris, the reader is referred to the excellent 
lectures of Broussais, in another part of this work. 

In Canada, and all the other places on this conti- 
nent where the disease has prevailed, it has exhibited 
the same symptoms as in Asia and Europe. Great 
hopes were long entertained that if the cholera should 
appear in this country, that our climate, habits, and 
sparseness of population would modify the disease, 
and mitigate its severity. But facts show us that 
such hopes are not to be realized, for the malady has 
been as fatal here as in Europe. 

Dr. Robert Nelson, member of the Medical Board 
and Commmissioner of Health at Montreal, thus de- 
scribes the mode of attack and symptoms of the dis- 
ease in Canada : — 

" During the first four or five days of the epidemic, 
the patient was subject, for the most part, in one of 
the two following modes : — 1st. After a trifling di- 
arrhea, of several days duration to a few hours only, 
nausea, quickly followed by vomiting, and an in- 
crease of diarrhea, would usher him into that stage of 
the disease, which may be called the 2nd mode of at- 
tack. 2d, The patient is affected with a slight blue- 
ness of hands and face, sometimes accompanied by 
a distressing sensation of weight and burning in the 
stomach, rapidly followed by vomiting and diarrhea ; 
when the vomting had once come on, the thirst would 
commence and be intolerable ; cramps in the limbs, 
and about the pericardia, blueness quickly extending 
towards the trunk ; profuse cold perspiration, (if per- 
spiration it be) and loss of voice. The severer cases 
would terminate in death, in a period from three to 
9* 



102 HISTORY OF THE 

six hours, while some might run on to twelve or 
more. 

After the first four or five days, the mode of attack 
was not so invariable, for while burning thirst, pain at 
the stomach, cramps, asphyxia, perspiration, cada- 
verous coldness and aphonia, characterized the mal- 
ady, vomiting and purging might be absent, and yet 
the case would rapidly run to a fatal termination. 

About this time, and still later, many cases assu- 
med a febrile character, the first pyrexial period of 
which might be called the choleric stage. But as 
the danger resided in this choleric stage, and the re- 
covery of the patient wholly depended on arresting 
some one or two of the symptoms, it will be proper, 
in order to found a rational mode of treatment, to an- 
alyse these latter. 

However, before taking up that subject, let us stop 
a moment to examine the matter voided. The mat- 
ter vomited was at first what happened to be in the 
stomach ; after that it was watery. The alvine dis- 
charges were without odor, in large quantities, whi- 
tish, like rice water, or a mixture of arrow root and 
water ; this white substance has been ascertained to 
be fibrin. Perspiration abundant, cold, and slightly 
adhesive as if mixed with dissolved epidermis — doubt- 
less it also contained fibrin 5 but this last fact has not 
been decided. 

Besides the intestinal canal and the skin, all other 
organs furnished no secretion. Tears, pituita, saliva 
and urine, the secretion of which is totally suspended ; 
as to tears, the greatest anguish of dying, in full pos- 
session of the intellect, surrounded by all that is at 
once endearing and afflicting, could not produce them. 
Some complained of great pain, and desired to make 



SYMPTOMS OF CHOLERA IN AMERICA. 103 

water, but the bladder contained no urine, and after 
death was found to be contracted to the smallest size ; 
this desire of voiding water might arise from the con- 
traction of the posterior disk of the bladder hard 
against the internal meatus, which on autopsy was 
found to be the fact. In this disease, there is every 
reason to believe that every species of secretion, in all 
parts of the body, is abolished. No known function 
of the intestinal mucous membrane could form mat- 
ter like unto that discharged, and as there is no cir- 
culation going on in the skin, but rather a complete 
state of asphyxia in that part, there can be no secre- 
tion of perspiration. We now naturally come to the 
question — Whence and how come these discharges ? 
On the skin, certainly not from circulation, for there, 
there is none — ex nihilo nihil fit — and it is more than 
probable, that the capillary circulation of the mucous 
membrane of the intestines is equally absent. It 
would appear as if the elements of the body, compo- 
sing the parts nearest to the surfaces, became subject 
to new affinities, forming new substance, incapable 
of being retained by the membranes, but rapidly 
oozing through them. Two facts go to support such 
an hypothesis. 1st. The abundant new formation 
transuded, where no circulation exists ; and 2d, the 
rapid amaigrissement of the body. This wasting of 
the body is not apparent, it is real ; the usual round- 
ness of parts is taken off, and tendons and other sali- 
ent points become strikingly prominent." 

In the cases which have occurred at New-York 
and Albany, the same symptoms have been noticed. 
The second week in July, I saw many cases of the 
disease in New-York, in all of which, the above 



104 History of the symptoms of cholera, &c. 

symptoms were present. First, diarrhea, though oft- 
en of only short duration, then nausea and vomiting, 
though in some instances the vomiting was slight, to 
which succeeded a sinking of the circulation, cold- 
ness and blueness of the surface, burning thirst, 
spasms, and death. In most of the cases that 1 have 
seen, the discharges from the the stomach and bowels 
were light colored, resembling arrow root and water, 
or starch and water, and were without odor. In 
many cases, however, vomiting and purging were not 
among the most prominent symptoms, and the stage 
of collapse or great prostration, did not appear to 
arise from profuse discharges, as in many of the cases 
the most remarkable for sudden prostration, coldness, 
blueness, &c, the patients had vomited or purged but 
very little. 

Having thus completed an account of the symp- 
toms of the cholera, as they have been witnessed in 
different parts of the world, we shall now give an ac- 
count of the appearances found on dissection of the 
bodies of those who have died of the disease in Asia, 
Europe, and in this country. 



APPEARANCES ON DISSECTION, &c. 

We have seen in the foregoing accounts of the 
symptoms of the epidemic cholera, selected from va^ 
rious writers, that a most remarkable uniformity oij 
symptoms has been noticed, in all countries where 
the disease has prevailed. The accounts of this dis- 
ease, from Asia, Persia, Russia, Poland, England, 
Canada, and the United States, all agree as respects 
the symptomatology, and as 1 have before observed,, 
the description of the symptoms of the cholera, as they 
were noticed in India, would be an accurate account 
of the epidemic, as it now appears in New York. 

But notwithstanding this agreement respecting the 
symptoms of the disease, we are surprised to find that 
the accounts of the morbid appearances discovered 
on the dissection of those who had died of the disease, 
are exceedingly variable, and often contradictory ; 
and as yet have thrown but little light on the pathol- 
ogy of the disease, or furnished any important gui- 
dance as regards the treatment of it. 

This disagreement respecting the morbid appear- 
ances, has not, however, arisen from any neglect of 
authors and observers to describe the appearances 
discovered on dissection ; but they have unquestion- 
ably been different ; and this difference has probably 
been caused by the greater violence of the disease in 
one case than in another ; by the age and constitution 
of patients, and the remedies administered. 



106 APPEARANCES ON* 

The accounts from India, respecting the morbid 
appearances, are numerous and full. 

The Bengal Medical Report, drawn up and pub- 
lished soon after the appearance of the disease in 
India, thus refers to the results of post mortem re- 
searches. 

" Of those who died, it was believed, perhaps rather 
fancifully, that the bodies sooner underwent putre- 
faction, than those of persons dying under the ordi- 
nary circumstances of mortality. The bodies of those 
who had sunk in the earlier stages of the malady, ex- 
hibited hardly any unhealthy appearance. Kven in 
them, however, it was observed, that the intestines 
were paler and more distended with air than usual ; 
and that the abdomen, upon ^>eing laid open, emitted 
a peculiar offensive odor, wholly different from the 
usual smell of dead subjects. In the bodies of those 
who had lived some time after the commencement of 
the attack, the stomach was generally of natural ap- 
pearance externally. The color of the intestines 
varied from deep rose to a dark hue ; according as 
the increased vascular action had been arterial or ve- 
nous. The stomach, on being cut into, was found 
filled, sometimes with a transparent, a green, or dark 
flaky fluid. On removing this, its internal coats in 
some cases were perfectly healthy ; in others, and 
more generally, they were crossed by streaks of a 
deep red 5 interspersed with spots of inflammation, 
made up of tissues of enlarged vessels. This ap- 
pearance was frequently continued to the duodenum. 
In a very few cases the whole internal surface of the 
stomach was covered with coagulable lymph ; on re- 
moving which, a bloody gelatine was found laid on 
the interior coat, in ridges or elevated streaks. The 



DISSECTION, &c. 107 

large intestines were sometimes filled, with muddy flu- 
id, sometimes livid, With dark bile, like tar ; just as 
the individual had died in the earlier or later periods 
of the attack, in most cases, the liver was enlar- 
ged, and gorged with blood. In a few it was large, 
soft, light-colored, with greyish spots, and not very 
turgid. In others again it was collapsed and flaccid. 
The gall bladder was, without exception, full of dark 
green or black bile. The spleen and thoracic vis- 
cera where in general healthy. The great venous 
vessels were usually gorged ; and in one case the 
left ventricle of the heart was extremely turgid. The 
brain was generally of natural appearance. In one 
or two instances, lymph was effused between its mem- 
branes, near the coronal suture, so as to cause ex- 
tensive adhesions. In other cases, the sinuses, and 
the veins leading to them, were stuffed with very dark 
blood." 

Dr. Burrell, of the 65th Regiment, thus described 
the appearances found on dissection, and the good 
effects of bleeding in cases that occurred among the 
European soldiers. 

" Seroof, 10th August, 1818. 

" As dissections of cases of cholera morbus w 7 ere 
not sent you along with my statement of the 28th 
ult. 1 beg to send you a few remarks on this subject. 

As congestion has been found in all our former fa- 
tal cases, 1 yesterday had another demonstrative in- 
stance of the eligibility of bleeding in cholera. 

John Stokes, of the 65th regiment, a man recov- 
ered from chronic syphilis, was attacked inour wards 
with vomiting and purging, at eight P. M. of the 8th 
inst. When seen, his hands and feet were cold, with 



108 APPEARANCES ON 

some rigidity. Under these circumstances, and he 
being of a weakly habit, bleeding (I may say unfor- 
tunately) was not used. The usual remedies, with 
^the hot bath, were tried. He died on the 9th inst., 
at two, P. M. 

In company with Dr. White, of the 2d N. I., and 
Assista,nt-surgeon O'Reilly, 65th regiment, I opened 
the body. The liver was found of a dark color, dis- 
tended with blood, and the gall-bladder full of bile. 
The spleen of an extremely blue color. The omen- 
tum inflamed, and veins filled in every part. The 
small arteries of the intestines of a lively red, and the 
colon contracted through its length to the size of a 
middle finger, and its calibre so small as hardly to 
allow a scalpel handle to be introduced. 

The veins of the stomach more particularly ar- 
rested our attention. On the great curvature, they 
were of an intermediate size, between a crow's and 
a common quill. These turgid veins were more ap- 
parent internally, and the most forcible injection could 
not have more completely filled the vessels. The 
mesenteric vessels, as well as the vessels of every 
other internal membrane, partook of this appearance 
of formerly increased action. The lungs were dark, 
and suffused with blood ; this, most probably, is the 
cause of the stertorous and labored breathing pre- 
sent in almost every fatal case. 

From former dissections, and the appearances in 
this case, little doubt ought to arise regarding the ex- 
igence of bleeding in almost every case, but more 
especially in the first hours of attack. If even during 
the cold and rigid state of the limbs, should the pulse 
rise in the hot bath, which it generally does, we ought 
not to hesitate in opening a vein; as recovery from 



DISSECTION, &c. 109 

this stage is most precarious, and every experiment 
may therefore be tried. 

As dissection in this disease has shown, and will 
in every case show, turgidity, if not inflammation, of 
the vessels of the internal parts, no hesitation as to 
what line of practice is best, should harbor in the 
minds of medical men during the prevalence of so 
dreadful a disease. 

Under this idea of increase bf action internally, 
and consequent want of balance in the circulation, 
from which arises the coldness and shrinking of the 
external parts, 1 commenced the bleeding system ; 
and of the cases admitted of cholera, since the 21st 
ultimo, up to the 10th August, the casualties run 
thus, 

Bled, 88 Dead, 2 

Not Bled. 12 Dead, 8 

Total admissions, 100 Deaths, 10 

Our cases of dysentery in the chronic stage, in the 
hospital, have been aggravated in many instances, ap- 
pearing as if the epidemic give a peculiar character of 
symptoms to the usual endemical diseases. 

Relapses of cholera have not been unfrequent, and 
the regularity of the bowels must be strictly attended 
to in the stages of convalescence. 

Some of these relapses require the same treatment 
i as the original attacks. In one European woman the 
attack proved fatal." 

The Madras Medical Report, drawn up by Mr, 
Scott, thus fully describes the morbid appearances dis- 
covered on dissection, by the medical men in India. 

•• The external appearance of European subjects, 



I f 




HO APPEARANCES ON 

who have sunk under cholera, closely resemble that 
which has been noticed as taking place during life. 
The surface is livid, the solids are shrunk, the skin of 
the hands and feet is corrugated. There seems no 
sufficient evidence of any uncommon tendency in the 
body to putrefaction after death, nor of any char- 
acteristic fetor from the abdominal cavity. No par- 
ticular morbid appearances have been found in any of 
the cavities of the body, which are lined with serous 
membranes, or in these membranes themselves. The 
cavities of the pleura, of the pericardium, and of the 
peritorium, have almost uniformly been found in a 
natural state ; or the deviations from that state have 
manifestly had no connexion w r ith cholera. The sur- 
faces which are lined, or covered with mucous mem- 
brai.es, have, on the contrary, very generally exhibit- 
ed signs of disease. These will be noticed, as the or- 
gans connected with them come to be mentioned. 

The lungs have not unfrequently been found in a 
natural state, even in cases where much oppression of 
respiration had existed previously to death. Much 
more generally, however, they have been found either 
to be gorged with dark blood, so that they have lost 
their characteristic appearance, and have assumed 
more that of liver or spleen ; or they have been found 
to be in the opposite state ; that is, collapsed into an 
extremely small bulk, and lying in the hollow on each 
side of the spine, leaving the cavity of the thorax near- 
ly empty. This appearance has been so remarkable 
as to induce Dr. Pollock, of H. M's. 53d regiment, to 
conceive, that it could only be produced by the extrica- 
tion of a gas within the cavity of the pleura, capable 
of overcoming the atmospheric pressure. It is under- 
stood, however, that opportunities were had of pier- 



DISSECTION, &c. Hi 

cing the thorax of the dead body under water., and 
that no gas was extricated. As there appears to have 
been an absolute vacancy in the cavity of the pleura, 
that is to say, the lungs did not by any means fill it, it 
would seem that the viscus had exerted a contractile 
power, adequate to overcome the pressure of the at- 
mosphere. The blood found in the lungs has been al- 
ways very black. The heart and its larger vessels 
have been found to be distended with blood, but not so 
generally as the apparent feebleness of their propel- 
ling power, and the evident retreat of the blood to the 
centre, would have led us to expect. The right auri- 
cle and ventricle being gorged with blood, is nothing 
peculiar to cholera ; but some dissections have shown 
the left cavities to be filled even with dark or black 
blood, which we may reckon as a morbid appearance 
more peculiar to it. In the abdominal cavity, the peri- 
toneal coverings of the viscera, being serous mem- 
branes, present in general but little deviation from the 
healthy state : occasionally, indeed, the morbid ac- 
cumulation of blood in the vessels of the viscera, im- 
parting an appearance of turgidity and blueness, is evi- 
dent on their exterior surfaces. We also find them 
bearing marks of inflammation, especially where the 
patient may have lingered before death. In other ca- 
ses, the whole tube has had a blanched appearance, 
both externally and internally. The stomach and in- 
intestines generally preserve their ordinary volume. 
The appearance of the omentum is not sensibly affect- 
ed in cholera. The stomach is found to be so various- 
ly affected, as to destroy all grounds for pathological 
reasoning. It is very rarely found empty or much 
contracted after death, nor has any appearance of 
spastic stricture of the pylorus been often detected. 



112 APPEARANCES ON 

It has, however, sometimes occurred. Its contents ap- 
pear to be chiefly the ingesta, in an unaltered state ; in 
some cases, greenish, or yellow, or turbid matters are 
found. The stomach has been said to have been 
found Mined with calomel/ Various appearances, 
either of active inflammation, or a congested state of 
the vessels, have been noticed, sometimes in one part, 
and sometimes in another. The parts seem as if they 
were sphacelated, thickened, softened, and friable ; 
and, in short, exhibit so great a variety of appearances, 
from a perfectly natural state, to the most morbid, that 
no particular light is thrown by them on the disease* 

The intestinal tube is sometimes collapsed, but oft- 
ener found to be more or less filled with air ; distend- 
ed in some parts into bags or pouches, containing whi- 
tish, turbid, dark, or green colored fluid ; and, in oth- 
ers, presenting the appearance of spastic constriction. 
The latter, however, is not common. No faecal or 
other solid matters are found in the intestines ; but, 
very commonly, large quantities of conjee-looking flu- 
id, or of turbid serous matter. The duodenum, and 
occasionally, the jejunum, have been found loaded with 
an adherent, whitish, or greenish mucus ; at other 
times they have been found seemingly denuded of their 
natural mucus ; and often perfectly healthy. Traces 
of bile in the intestines, or of any substance apparently 
descended from the stomach, are exceedingly rare. 
Sanguineous congestion, and even active inflammation, 
are stated to be more common in the bowels than in 
the stomach ; but, on the other hand, instances are 
very numerous where no such indications have been 
detected. The thoracic duct is stated to have been 
empty of chyle. The liver has been commonly found 
gorged with blood, but not always ; it is an organ usu- 



*$$ 



DISSECTION, &c. 113 



ally very vascular ; and it would probably demand a 
nicer discrimination than has been bestowed on the 
subject, to distinguish the degree of congestion in 
which it is naturally left by the settling of the blood 
after death in ordinary diseases, from that which has 
been observed after an attack of cholera. The gall 
bladder has almost universally been found to contain 
the bile, and, in the great majority of cases, even to 
be completely filled with it. As is usual with this 
secretion, in cases of retention, it is of a dark color. 
Very different states of the gall-ducts have been de- 
scribed ; cases of constriction and impermeability, 
seeming to be equally numerous with those of an op- 
posite character. 

The urinary bladder is found, we may say uni- 
versally, without urine, and very much contracted. 
The lining of mucous membranes of the bladder and 
ureters, have been found coated with a white mucous 
fluid. The smallness of the bladder, after death, has 
been generally adduced in proof of great spasms ; but 
it is not unfrequently found to be equally small after 
death, from other diseases ; and it seems the nature 
of that organ, when it contains no urine, to contract, 
so as to leave no cavity. Dr. Baillie, in his morbid 
anatomy, thus notices this fact. ' The bladder is al- 
so found contracted to such a degree as hardly to 
have any cavity. This is generally not to be consid- 
ered as a disease, but simply as having arisen from a 
very strong action of the muscular coat of the blad- 
der previously to death.' The appearance of the 
spleen, which is so various under the ordinary condi- 
tions of the body after death, has indicated nothing 
that can be mentioned as belonging to cholera. The 

vessels of the mesentery have been very generally 
10* 



114 APPEARANCES ON 

found to be uncommonly full of blood; In the head, 
appearances of congestion, and even of extravasation, 
have been frequently observed ; but not so uniformly 
nor to such extent as to require any particular notice. 
Only one case has been given where the state of the 
spinal marrow was examined 5 and, in that, indica- 
tions of great inflammation were detected in its 
sheath ; the case, however, was, in some degree, a 
mixed one. 

From this general view of the appearances found 
on dissection of the bodies of persons who have died 
from cholera, it is manifest that the information 
thence derivable, is, in a pathological view, of a neg- 
ative nature only. It is nevertheless of consequence, 
in a practical sense, especially in treating the seque- 
lae of cholera*" 

Dr. John Kinnis, in a report addressed to Sir James 
M'Gregor, Director General of the Medical Depart- 
ment of the Army, thus sums up the morbid appear- 
ances in those who died of cholera at Mauritius, in 
1819 and 182-0:— 

" In one case, the brain was mangled by an officious 
orderly, during a momentary absence of the operator ; 
and in another, appeared natural ; but in all the rest, 
there was serous effusion into the ventricles ; and in 
the greater number, likewise between the membranes 
and on the base of the cranium 5 when between the 
membranes, before these were divided, it resembled 
a transparent jelly. 

In exactly one half of the cases, there was effusion 
under the dura mater of the spinal cord. The veins 
of its pia mater generally appeared very turgid, but. 
having very lately begun to examine the spine on dis- 



DISSECTION, &c. 115 

section, I was doubtful whether to consider this a 
natural or a morbid appearance, and seldom noted it 
down. In one case, the blood contained in these 
vessels was of an arterial color, resembling a coarse 
injection ; in another, it was partly venous and partly 
arterial. 

The circulating system presented, in general, no 
deviation from the usual appearances; none of that 
congestion in the lungs or any of the viscera, which 
others have found, and which seemed to offer so plau- 
sible an explanation of the most remarkable symp- 
toms attending the disease. In one case, all the cav- 
ities of the heart were empty ; and in three, the inter- 
stices betwixt its columns carneae and musculi 
pectinati, filled with a frothy blood. In two cases, 
the heart appeared unusually flaccid ; and in one of 
them, the parietes of its left ventricle unusually thin. 
Once the pericardium contained two drachms of a 
pale reddish fluid. 

The abdominal viscera seldom presented any 
thing unusual externally ; yet in one case there was 
scattered over them gelatinous, semi-transparent 
flakes, and the abdomen contained half a pint of se- 
rum. The small intestines exhibited in four cases 
a very light arterial blush, and in the one where this 
appearance was most distinct, the omentum adhered 
to the peritonaeum for some inches on the right side. 
In several cases, the large intestines and the mesen- 
tery were loaded with venous blood, and in two, the 
lower portion of the ilium, and the large intestines, 
were blue, or greenish blue externally, and dark red 
internally. 

The speckles, natural to the mucous coat of the 
stomach, were sometimes merely paler than usual, 



116 APPEARANCES ON 

or of a dark venous hue ; in other cases, instead of a 
speckled surface, there were large black or greyish 
black patches, at one time distinct, at another coales- 
cing into ridges upon the rugae of the stomach, and 
apparently arising from effused blood. Where mer- 
cury had been taken in great quantity, these patches 
were few in number, or rather obscured by a black 
or dull green thick ropy mucus, which lined the sto- 
mach, and was interspersed with greyish portions ; 
in such cases, the stomach contained a considerable 
quantity of a similar substance, in a more liquid form ; 
in one case it contained a thick grey and dark red- 
dish colored mucus. 

The small intestines were generally thickened, and 
lined with a substance resembling in color and con- 
sistence shoemaker's paste* In eight of the cases 
examined, the lumbricus teres was found imbedded 
in this substance, sometimes to the number of eight or 
nine ; and one patient, in whom none were found on 
dissection, had vomited them before death.* 

The large intestines were either contracted and 
empty, or filled with a greyish white puriform, some- 
times foetid, or dark brown fluid. In one case, the 
rectum resembled an hour glass, being distended with 
fluid, and contracted in the middle. 

In three or four instances, the gall-bladder was 
flaccid 5 in general, it was distended beyond the mar- 
gin of the liver, with blackish green thick bile. It 
was, in one subject, whitish, translucent, and about 

* My friend, Mr. Gillespie, one of the surgeons to the civil hospi- 
tal, informs me, that he has seldom had occasion to open a Black 
subject, without finding worms in the intestines. Whether they may 
equally infest European adults in this island, I have yet had few 
opportunities to determine. They are here, as every where else, 
very common in children. 



DISSECTION, &c. 117 

an inch from its fundus, divided by a narrow neck 
into two bags, both of which were filled with a thin 
white fluid, intermixed with purulent looking flakes ; 
the cystic duct appeared at first imperforate, but with 
a very little force, the probe could be passed to the 
duodenum. The gall-bladder communicated freely 
with that gut, in every other case. 

In the patient who had complained of inability to 
void urine, the bladder was contracted and empty, 
as it almost always is after death. 

Dr. Annesley, who has furnished one of the best 
descriptions of the disease, finds from Autopsic inves- 
tigation that the intestines present a vermilion color, 
which he says is peculiar to the disease. Dr. A. fur- 
ther declares that the anatomical appearances are the 
same in all the cases he examined. 

Dr. Alexander Gordon, a surgeon attached to the 
Bombay Presidency, a man of great merit, and who 
fell a victim to the disease, says the lesions of the brain 
were primitive and essential, while those of the intes- 
tines were only secondary. 

In Europe, the same diversity of morbid appearan- 
ces have been noticed, as have been found in India, 
Dr. Kier, in a report respecting the cholera at Mos- 
cow, in the autumn of 1830, thus describes the post 
mortem appearances : 

" The appearances in the dead bodies were not 
uniform, and varied according to the duration of the 
disease, and the circumstances under which the pa- 
tient had died. As this was the case, I conceive the 
most satisfactory way by which I can answer the in- 
quiry on this head will be to transmit the printed ac- 
counts of the dissections made at Moscow, and pre- 



118 APPEARANCES ON 

sented to the Medical Council there, by its members 
who occupied themselves the most with this part of 
the duty ; while 1 here add the impressions made on 
my own mind, by the dissections at which I was 
present. 

The extremities in genera!, were more or less livid 
and contracted, and the skin of the hands and feet 
corrugated, the features sunk and ghastly ; on open- 
ing the scull, the blood-vessels of the brain and its 
membranes were more or less turgid with blood, par- 
ticularly towards the base ; the arachnoidea had 
sometimes in several places lost its transparency, and 
adhered to the pia mater ; a fluid was sometimes 
found effused into the convolutions of the brain, in 
some quantity, and more or less serum in the lateral 
ventricles. The blood-vessels of the vertebral col- 
umn and spinal chord, more or less loaded with 
blood, which was sometimes effused between its 
arachnoid and dura mater ; partial softening of the 
substance of the spinal chord was sometimes met 
with, and marks of inflammatory congestion in the 
larger nerves. The lungs were generally gorged with 
dark-colored blood, the cavities of the heart filled with 
the same, and frequently containing polypous concre- 
tions. In all the dissections 1 was present at, very 
dark-colored blood, which, when extended on a white 
surface, resembled the color of the darkest cherry, 
was found in the arch of the aorta, and in other arte- 
ries. 

The state of the abdominal organs varied conside- 
rably, the stomach and different parts of the intestines 
were frequently found to be partially, but considerably 
contracted ; the internal surface of the stomach some- 
times seems to be little affected. A whitish or yellow 



3*fc£ 



DISSECTION, &c. 119 

fluid matter resembling the evacuations, was fre-- 
quently found in the alimentary canal, which now 
and, then contained a good deal of air. In either 
case, both stomach and intestines bore marks of con- 
gestion, and of a' sub-inflammatory state, varying 
from dark-colored spots of small extent, to several 
inches, affecting the whole internal surface of the in- 
testines. The color of these parts also varied a good 
deal, from dark-colored venous congestion, to rose- 
colored inflammation. In one case, the internal sur- 
face of the stomach was so strongly and so generally 
tinged of a very dark color, that it might easily have 
been mistaken for gangrene. On exposing the stom- 
ach between the eye and the light, it was evident that 
there was neither gangrene, nor solution of continuity, 
but that the dark color proceeded from a very general 
and great congestion of very dark colored blood, in 
the vessels of the organ. The subject of this case, 1 
was told, had died with symptoms of a typhoid nature, 
after suffering fromtheusual symptoms of the epidem- 
ic. Excepting in this case, which was evidently one 
of congestion, and not of inflammation, I saw nothing 
in the morbid appearances from which a conclusion 
could be drawn, that inflammation was a very gene- 
ral morbid change in the alimentary canal, or a com- 
mon cause of death : however, by its presence in 
the second period of the disease, it might add to the 
general irritation, or, even as a consequence of prece- 
ding congestion, be itself occasionally, the cause of 
the fatal event. Both stomach and bowels were fre- 
quently of a paler color than natural, both on the out- 
er and inner surface ; but neither thickening nor con- 
densation from inflammation, nor exulceration, de- 



120 APPEARANCES ON 

struction of substance, nor abscess, appeared in any 
of the dissections 1 was present at. 

The liver was generally pretty full of dark-colored 
blood, the gall-bladder frequently much distended 
with tenacious ropy bile, of a dark yellow or green 
color ; the gall-ducts sometimes contracted, at other 
times not; the appearance of the pancreas, spleen, 
and kidneys was various, frequently differing but little 
from their natural state, in other cases, rather sur- 
charged with blood, the urinary bladder almost 
always collapsed and empty, the uterus generally 
natural." 

The Medico-Chirurgical Review for 1832, thus 
describes the results of post mortem inspections in 
England : 

" Dissection of the subjects dead of this disease, 
have not been frequently performed : the same preju- 
dices of the ignorant multitude have forbidden it here, 
as in all other countries. Yet so far as opportunities 
have been afforded, and these have been few indeed, 
the same general appearances, and similar varieties 
in different cases, have been observed in this country. 

The entire absence of faecal matter in the contents 
of the intestines: the presence, in greater or less 
quantity, of matter such as the peculiar evacuation ; 
the serum-like fluid, more or less abounding with 
floculi of coagulated albumen, which are occasional- 
ly found in such quantity, as to line the mucous mem- 
brane with a tenacious substance, like paste ; an 
odor of putrifying mucus, somewhat like that of offen- 
sive lochial discharges, occasionally present ; the se- 
rous fluid being frequently more or less tinged with 
blood, and that of the stomach often mixed with the 



DISSECTION, &c. 121 

latest ingesta ; the upper part of the duodenum often 
slightly tinged with bile ; frequently contractions of 
different portions of the colon; occasionally introsus- 
ceptions ; the gall-bladder distended with unhealthy 
bile ; its ducts sometimes strictured, and the urinary 
bladder empty and remarkably contracted. 

The mucous membrane of the alimentary canal, 
generally somewhat softened; sometimes of an un- 
natural paleness throughout, but oftener having vari- 
ous portions tinted of different hues, from the pale 
rose, to dark brick-dust and slate colors, as venous or 
arterial injection predominates; patches of ecchymo- 
sis and arborisations of the larger branches are fre- 
quent ; but the most common appearances have been 
a red or purplish speckling of the membrane, general- 
ly over the whole, or more apparent in some parts 
than in others { or an injection confined to the promi- 
nent parts of the rugae of the stomach and valvulse 
conniventes of the intestines. Sometimes these dif- 
ferent appearances are scattered throughout tho 
whole extent of the mucous membrane ; at other 
times, the stomach alone is colored, and the intestines 
pale, or the stomach pale, and different portions of the 
intestines darkly injected ; however, these appearan- 
ces are most frequent about the smaller extremity of 
the stomach and lower portion of the ileum. The ve- 
nous trunks of the stomach and intestines .are gene- 
rally found greatly engorged ; such also frequently 
takes place with the liver and spleen, and almost in 
every case in the venee cavse, and auricles of the heart. 
The blood remaining fluid, of an exceeding dark and 
peculiar consistence and adhesiveness, likened by 
some to treacle poured over the cavities of the heart. 

The lungs frequently exhibit a remarkable shrinking, 

11 



122 APPEARANCES ON 

like that of the skin and subcutaneous tissues (which 
Jed in India to the body being opened under water, to 
ascertain if air existed in the cavity of the pleura), 
then blood of the same dark hue; frequently they 
are engorged so as to resemble hepatization some- 
what, but still crepitous and lighter than water. The 
obstruction of the bronchise, by peculiar secretions, 
has not here been noticed amongst the cases from 
the North of England: the brain of two only has 
been examined ; in one, the vessels were very turgid, 
and half an ounce of serum was contained in the la- 
teral ventricles; in the other, a very highly injected 
state of the vessels externally to the brain, and in the 
cortical substance of the upper parts of the hemi- 
spheres, and in the cortical substance or upper part 
of the medulla oblongata was found, with depositions 
of lymph upon the surface of the brain and cerebellum, 
and five or six ounces of serum in the base of the 
skull. 

Turgesence of the vessels of the brain and spine 
has been at all places a very frequent appearance, 
and serous effusion beneath the arachnoid in the cavi- 
ty of the cranium and spinal canal, and in the lateral 
ventricles! It has seldom been observed how often 
these appearances have existed ; but in the report of 
Dr. Kinnis, from the Mauritius, decidedly the best 
of any which have yet been published, as affording 
the greatest extent of information on the many impor- 
tant considerations connected with the cholera, in 13 
cases, where the brain was examined, serous effusion 
was found in all but two, one of which appeared na- 
tural, the other was mangled by an officious orderly 
during a momentary absence of the operator, and in 
one half of the cases where the spine was examined, 



DISSECTION, &c. 123 

there was effusion under the dura mater of the cord, 
and the veins generally turgid. 

It has been a general complaint, that the state of 
the organs after death has thrown no light on the na- 
ture or causes of the disease, and that they afford no 
explanation of the severity of the symptoms. It is 
true that they do not explain these, as the inflamma- 
tion, tumefaction of the membrane, and fibrinous effu- 
sion in croup does the affection of the voice, and suffo- 
cation met with in that malady ; but they do throw 
as much light, as post mortem examinations in gene- 
ral, on the seat and nature of diseases; and this in- 
stance may serve as a useful comment on the present 
mania for the exclusive cultivation of morbid anato- 
my : we feel and acknowledge its great advantages, 
and the precision in this obscure science, which is de- 
rived from such researches j but the man who wishes 
to treat disease successfully, must not consider his 
only aim and object to be the knowledge of the vari- 
ous morbid changes which take place in the structure 
of the different organs, and of the symptoms by which 
they are distinguished ; his researches must be direct- 
ed beyond this — to the laws of vital actions; to the 
manner in which they are disordered, and to the 
agents capable of restoring them to their healthy state. 

We regret exceedingly that any idea of post mor- 
tem examinations being of little utility in investiga- 
tions into the nature of the disease, should have 
thrown a damp on the interest with which they have 
been prosecuted, and thus have deprived us of much 
valuable information. It is, unquestionably, impor- 
tant to ascertain if any connexion exists between the 
various fatal forms of the cholera, and the different 
pathological conditions of the organs affected : but 



126 APPEARANCES ON 

Post Mortem Examination ten hours after death. 

Examination of Margaret Black's body. On open- 
ing the chest and abdomen, the omentum exhibited 
no unnatural appearance; the mesenteric veins were 
in a state of complete congestion ; the stomach con- 
tained from two to three pounds of the same veal 
soup-like fluid as had been vomited during life ; the 
internal and peritoneal linings were very pale and 
bloodless, and in several parts there were vascular 
patches ; the duodenum contained a quantity of the 
same turbid fluid, which the whole canal was less or 
more filled with ; the lining of the pylorus was unu- 
sually pale, but there were a few gangrenous patch- 
es on it 5 a considerable quantity of pearly colored 
mucous was found covering the lining membrane of 
the intestines ; submuriate of mercury was blended 
intimately with this mucous, which produced the ap- 
pearance of black-wash, proving, perhaps, that lime 
was present. Super-carbonate of soda was mixed 
with another portion of it, but no effervescence took 
place. Spleen much darker than natural, and more 
engorged with black blood ; liver pale, of a mottled 
appearance, and much softer than natural ; gall blad- 
der about two thirds full of a very dark green bile ; 
gall ducts not closed or filled up, so that bile could 
be pressed out of the bladder with ease ; lungs w^ere 
of a dark mottled appearance. Left lung of a dark 
buff color, and highly congested, — right lung extreme- 
ly dark and gorged with grumous black blood ; heart 
appeared of a natural size, — both right and left ven- 
tricle contained about two ounces of coagulated 
black blood, both ventricles were also distended with 
the same impure blood, particularly the right ; kid- 
ney was pale and bloodless, bladder entirely empty, 



DISSECTION, &c. 127 

and contracted to a great degree. A number of gan- 
grenous patches in the lining membrane of bladder. 

Post Mortem Temperature. — Apartment, 58 Fah- 
renheit. 

Temperature of the Body. — Half-past three o'clock, 
82— half past 4, 90—5, 92—6, 96— half-past 6, 96— 
7,90. 

Second Case. 

Walter Hovveiston was admitted into Vennel Hos- 
pital on the 21st March, at half past nine, A. M. in a 
complete state of collapse, and died at two, P. M. the 
same day, after energetic treatment by enemata, cal- 
omel, opium, and latterly, a tobacco injection. 

Examination after death. — Lungs seemed healthy ; 
heart of usual size, and contained two or three oun- 
ces of grumous blood in each auricle ; liver paler than 
natural; gall bladder full of bile, and easily dischar- 
ged ; spleen healthy ; stomach contained a great quan- 
tity of fluid resembling dish w r ater. Towards the 
pylorus, in the inner membrane of the stomach, there 
were several patches, approaching to gangrene ; duo- 
denum much injected ; much glary fluid adhering to 
the whole inner coat of the bowels ; kidneys pale, and 
the left contained pus; bladder firmly contracted ; no 
urine ; gangrenous patches at the fundus of the stom- 
ach 5 did not examine the brain. 
Third Case. 

Robert Forfar, eetatis 12, idiot. Epilepsy since 3 
years old. Was in the habit of eating coals and any 
other dirt. Had purging three days previous to attack. 
Was seized on Sunday morning, Jan. 22, at 3 o'clock, 
I with both vomiting and purging, but no cramps. Vi- 
sited at 12 o'clock — found the patient laboring under 



i 



126 APPEARANCES ON 

Post Mortem Examination ten hours after death. 

Examination of Margaret Black's body. On open- 
ing the chest and abdomen, the omentum exhibited 
no unnatural appearance; the mesenteric veins were 
in a state of complete congestion ; the stomach con- 
tained from two to three pounds of the same veal 
soup-like fluid as had been vomited during life ; the 
internal and peritoneal linings were very pale and 
bloodless, and in several parts there were vascular 
patches ; the duodenum contained a quantity of the 
same turbid fluid, which the whole canal was less or 
more filled with; the lining of the pylorus was unu- 
sually pale, but there were a few gangrenous patch- 
es on it; a considerable quantity of pearly colored 
mucous was found covering the lining membrane of 
the intestines ; submuriate of mercury was blended 
intimately with this mucous, which produced the ap- 
pearance of black-wash, proving, perhaps, that lime 
was present. Super-carbonate of soda was mixed 
with another portion of it, but no effervescence took 
place. Spleen much darker than natural, and more 
engorged with black blood ; liver pale, of a mottled 
appearance, and much softer than natural ; gall blad- 
der about two thirds full of a very dark green bile ; 
gall ducts not closed or filled up, so that bile could 
be pressed out of the bladder with ease ; lungs were 
of a dark mottled appearance. Left lung of a dark 
bufif color, and highly congested, — right lung extreme- 
ly dark and gorged with grumous black blood ; heart 
appeared of a natural size, — both right and left ven- 
tricle contained about two ounces of coagulated 
black blood, both ventricles were also distended with 
the same impure blood, particularly the right ; kid- 
ney was pale and bloodless, bladder entirely empty, 



DISSECTION, &c. 127 

and contracted to a great degree. A number of gan- 
grenous patches in the lining membrane of bladder. 

Post Mortem Temperature. — Apartment, 58 Fah- 
renheit. 

Temperature oj the Body. — Half-past three o'clock, 
82— half past 4, 90—5, 92—6, 96— half-past 6, 96— 
7,90. 

Second Case. 

Walter Howeiston was admitted into Vennel Hos- 
pital on the 21st March, at half past nine, A. M. in a 
complete state of collapse, and died at two, P. M. the 
same day, after energetic treatment by enemata, cal- 
omel, opium, and latterly, a tobacco injection. 

Examination after death. — Lungs seemed healthy ; 
heart of usual size, and contained two or three oun- 
ces of grumous blood in each auricle ; liver paler than 
natural; gall bladder full of bile, and easily dischar- 
ged ; spleen healthy ; stomach contained a great quan- 
tity of fluid resembling dish w r ater. Towards the 
pylorus, in the inner membrane of the stomach, there 
were several patches, approaching to gangrene ; duo- 
denum much injected ; much glary fluid adhering to 
the whole inner coat of the bowels ; kidneys pale, and 
the left contained pus; bladder firmly contracted ; no 
urine ; gangrenous patches at the fundus of the stom- 
ach ; did not examine the brain. 
Third Case. 

Robert Forfar, aetatis 12, idiot. Epilepsy since 3 
years old. Was in the habit of eating coals and any 
other dirt. Had purging three days previous to attack. 
Was seized on Sunday morning, Jan. 22, at 3 o'clock, 
with both vomiting and purging, but no cramps. Vi- 
sited at 12 o'clock — found the patient laboring under 



128 APPEARANCES ON 

well marked symptoms of cholera, and quite cold. 
Enema of warm starch, one pound, tincture of opium 
three drachms. 

Monday.— Much in the same state, though he look- 
ed better. Still cold, but not so livid. Continue med- 
icine and hot applications. 

Tuesday. — Continued in same state until 4 P. M., 
when the surface of his body became warmer, which 
continued until his death, which took place at 9 P. 
M. The patient was warmer two hours before his 
death, than he was two days before. Had a purging 
enema at 2 o'clock this day, which produced a bilious 
stool, with a long round worm in it. No urine was 
secreted or voided since three o'clock on Sunday 
morning. 

Examination of Robert Forfar >s body, 25th Jan. 
1832. — Sixteen hours dead. No offensive odor. 
The surface of the body leaden hue. Belly hollow. 
Reddish ecchymosis of the limbs. Pupil nearly na- 
tural. No difference in the color of the muscles or 
fat. On laying back the sternum the internal mamma- 
ry artery and veins were displayed. The blood in 
the artery certainly lighter red than in the vein, not 
more turbid than natural. Very collapsed lungs. No 
fluid in the chest. Upper surface of the liver darker 
than natural, but posterior natural. Gall bladder 
very turgid. All the bowels much injected with 
blood except the colon. The Neurilema of the 
pneumogastric nerves bright red and injected. Right 
side of the heart relaxed, left contracted. Spleen 
natural. The injection of the intestines is very minute, 
exceedingly distinct and arborescent. Some grum- 
ous blood in the right ventricle. There is also some 
blood in the left ventricle, which is more coagulated. 



DISSECTION, &c. 22^ 

Internal texture of the liver natural. Blood in the 
stomach dark brown, the villi injected, (and Mr, 
Earle. of London, who is present, says that in some 
parts of the stomach it is exactly like the stomachs of 
those who die of hydrophobia,) corrugated in a pecu- 
liar way, more particularly about the rugee. This 
dark fluid adheres tenaciously to the coats of the 
stomach, and through the whole line of the intestines, 
except the colon. At the commencement of the jegu- 
num an indurated superficial ulcer, size of a six- 
pence. About half a table-spoonful of urine in 
bladder. Several large dead lumbrici. Kidney na- 
tural, but darkish. 

Chemical examination of Urine taken from the Mad-, 
der on Wednesday, during the post mortem examina-* 
Hon, — Was acid, and if it contained urea at all, it 
contained it in a very minute quantity. 

Examination of the Bile. Ten grains dried at a 
heat of 140, calcined, left one grain. Distilled water 
poured on this and heated, slightly restored reddened 
litmus. 

Blood.— A quantity of blood was collected from 
the heart. It was gelatinous, but the greater part 
appeared to have remained fluid. The whole collect- 
ed was dried at a heat of 140. The mass after ex- 
siccation weighed 200 grains, which, by exposure in 
a crucible to a red heat for two hours, was reduced 
to two grains. Boiling distilled water was poured 
on these, till nothing more was dissolved. The inso- 
luble mass weighed one and three-fourth grains. 
Hence 200 grains of this blood dried at 140, only 
contained one fourth grain of salts soluble in water. 
These consisted of an alkaline carbonate, muriate 
and sulphate of soda. The following experiments 



130 APPEARANCES ON 

with this aqueous solution show — 1st, Turmeric pa- 
per was not reddened, but the blue color of litmus 
reddened by an acid was very gradually restored. 
2d, Muriate of silver, a copious precipitate, insoluble 
in nitric acid. 3d, Nitrate of barytes, a copious pre- 
cipitate, insoluble in nitric acid. 

A young friend who accompanied me to Newcas- 
tle, and who has been for several years much en- 
gaged in the investigations of animal chemistry, has 
communicated to me the following as the result of 
his inquiries : — 

1st, In the fluid vomited which you brought from 
Newburn, there was neither free acid nor free alkali, 
nor albumen. It, however, contained a peculiar 
animal matter, for when it was slowly evaporated at 
a low heat, a yellowish brown extract remained, re- 
sembling in appearance that of urine. Its chemical 
properties were, however, wholly dissimilar, as it 
contained no urea, or matter capable of causing a 
precipitate with the tincture of galls. 

2d, The alkaline muriates and phosphates appear- 
ed to be present in the clear fluid. The insoluble 
rice-looking matter was not sufficiently examined to 
speak with confidence of its nature. Blood taken 
from the heart of a blue collapse patient was not ma- 
terially altered in any of its chemical properties. It 
reddened by immersion in saline solutions immediate- 
ly, but scarcely at all by exposure to the air. This 
has been the case with the blood I have examined in 
three other bad cases of the disease. The saline 
matter of the blood appeared, by examination, to be 
greatly diminished in quantity. 

The bile appeared wholly unchanged in its chem- 



! 



: 



DISSECTION, &c. 23! 

i ical properties. Its physical properties were also the 
same as usual. 

The child's dejection, sent to you by Mr. Frost, 
consisted of a dilute solution of albumen. It redden- 
ed turmeric paper strongly. Solution of, the by-chlo- 
ride of mercury dropped into it, and the mixture 
heated, a copious precipitate fell. The same result 
obtained with nitric and muriatic acids in a slighter 
degree. These remarks only apply to the fluid part 
of it. The rice-like sediment was not examined. 

P. S.— The Gall duct of Forfar's case was found 
completely impervious. 

Fourth Case. 
From the Case-Book of Fennel Hospital 
Feb. 1332. Malcolm M'Millan, aged J 3, em- 
ployed constantly in his father's pilot boat, was 
brought to the Hospital in a state of collapse. His 
'extremities cold and blue ; no pulsation to be felt at 
the wrist, temples, or carotids ; face and lips very 
cold s countenance dull 5 eyes suffused ; eyelids slug- 
gish • tongue soft, clean, cold ; voice very feeble, and 
said by his friends to be completely altered ; is ration- 
al and drowsy ; complains of pain at and below the 
navel which is not increased on pressure. Half-past 
three. Has had an evacuation of about three ounces 
of a light brown colored fluid, resembling boiled oat- 
meal gruel, and of a slightly feculent smell. Four 
o'clock. Apply a mustard poultice to feet ; has more 
heat in his body and extremities; pulse perceptible 
at the wrist, 108 j has some thirst • to have four grains 
of calomel, and a small quantity of brandy and wa- 
ter. Quarter past five. Symptoms muchthe same ; 



132 APPEARANCES ON 

repeat the calomel. Six o'clock. Pulse impercepti- 
ble 5 had a little brandy and water. Quarter to 
seven. Pulse perceptible ; repeat the calomel. Half 
past seven. Pulse very feeble, 1 16 ; delirious. Half 
past eight. Repeat the calomel. JNine, P. M. Pulse 
imperceptible; skin colder; face pale; eyes more 
sunken ; repeated the brandy and water ; injected an 
enema of three pounds of water, as hot as the hand 
could bear, to which add an ounce and half of spirits 
of wine. Ten, P. M. Face bedewed with cold clam- 
my perspiration ; pulse still imperceptible; extremi- 
ties warmer; has retained the enema; repeated 
calomel and diluted alcohol. Eleven. Withdrew 
the enema and injected another, with three pounds 
of water and two ounces of brandy, and one drachm 
of laudanum. Twelve. Continue medicine ; pulse 
134. Half-past twelve. Pulse imperceptible ; ex- 
tremities rather cold ; eyes suffused. Dr. Kirk now 
pronounces the case incurable, from the state in 
which he finds the brain. One, A. M. Reparations 
34 in a minute, oppressed ; pulse imperceptible at 
carotid; chest laboring; heat not increased; much 
low moaning, of the most piteous description. Had 
two drachms of alcohol in a little cold water a few 
minutes since. Quarter past one. Countenance is 
indescribably dark, sunk and cadaverous ; no evacua- 
tions or vomiting. Twenty minutespast one. Breath- 
ed his last. 

Examination of M . HP Miliarias body Twelve Hours 
after Death. — Ecchymosis of the lower limbs and 
outside of arms ; abdominal viscera immensely in- 
jected, as in high inflammation ; lungs collapsed; 
blood fluid ; coagulable lymph filling the whole right 
ventricle as a polypus, and a small polypus in the 



DISSECTION, &c. 133 

left ; the various ganglia highly injected and redden- 
ed : bladder empty, corrugated, and injected ; inter- 
nal membrane of the bladder highly injected, like 
acute inflammation ; heat of the apartment 58 ; ther- 
mometer in the bowels 89; internal membrane of 
bowels injected highly ; glary matter like dirty mu- 
cous lining the whole cavity of the stomach and ileum ; 
spleen turgid ; considerable quantities of pus in pel- 
vis of kidney, and whole substance containing more 
blood than natural ; gall bladder distended ; the lon- 
gitudinal sinus of the brain containing in its whole 
length a polypus, like a white worm, very firm in tex- 
ture ; membrane of brain highly injected. 

Post Mortem Temperature of the Skin. — Half-past 
1 o'clock, 92—2, 92— half-past 2, 96—3, half-past 3, 
96—4, 90. 

In Canada and the United States, the results o* 
Post Mortem examinations have been no more uni- 
form and satisfactory than those furnished from India 
and Europe, but for further details respecting the 
cholera in this country the reader is referred to the 
appendix to this work. 

12 



TREATMENT OF THE CHOLERA. 

Notwithstanding the prevalence of this disease 
year after year in various parts of Asia, we yet find 
that no fixed plan of treatment has been adopted or 
discovered in that country. In India the treatment 
of the cholera has been altogether empirical. Nu- 
merous remedies were proposed, administered, com- 
mended and condemned. 

There is scarcely a remedy or medicine that can 
be thought of, or imagined, that was not tried in some 
of the towns in India, where the cholera prevailed. 
Among the principal remedies, were bloodletting, 
calomel in large doses, opium in a great variety of 
forms and in great and small quantities, and by in- 
jection ; ether, camphor, musk, castor, aromatic and 
stimulating tinctures, essential oils of peppermint, 
clove, cinnamon ; wine, ardent spirits, external heat, 
warm bath, and hot bath, to blister the extremities ; 
vapor bath, heated sand, friction with irritating ru- 
befacients, blisters, the actual cautery applied near 
the spine, and to the limbs, emetics, purgatives, gal- 
vanism, electricity, cold bath, &c- &c. &c. 

In the onset of the disease bloodletting was gene- 
rally considered useful, but for the most part it was 
serviceable only in the first stage of the disease, 
though some few instances are given in which blood- 
letting performed at an advanced period of the dis- 
ease proved beneficial. 

Calomel was very greatly administered in India in 
cases of cholera, and its efficacy very generally ac- 



TREATMENT OF THE CHOLERA. 185 

knowledged ; but we know that the mortality of the 
disease was exceedingly great in that part of the 
world, although nearly all the physicians gave calo- 
mel to their patients. 

Opium was also employed to a great extent ; and 
under the use of it many died, and some recovered ; 
and the same may be said of the efficacy of most of 
the remedies resorted to. 

When we pass from Asia to Europe, and inquire 
respecting the treatment of cholera, in a northern 
climate, we find the same remedies resorted to, that 
where used in India, with some few additional ones, 
proposed and employed by European physicians, but 
all with nearly like success to those that had been 
formerly used. 

Calomel has not however been so largely employ- 
ed in Europe as in India. 

In Russia, Poland and some other places, the ex- 
tracts of hyoscyamus and cicuta were administered, 
and it is said with remarkable success. 

The distilled water of cherry-laurel, and the dis- 
tilled water of bitter almonds, were said to have been 
of service in many cases. 

Tobacco injections have been highly recommended 
and many cases of cholera have been cured by the 
use of them. 

The siib-nitrate of bismuth was for a while highly 
recommended and reported to have cured many. 

Cinchona, serpentaria, capsicum, and various 
other tonics and stimulants, separate and combined, 
were proposed and administered, and in many in- 
stances seemed to be beneficial 5 but we all know 
that the mortality of the disease has been great in all 
countries* and consequently we may feel assured that 



136 TREATMENT OF 

no remedies have as yet been resorted to which have 
generally proved serviceable, or that have not failed 
in innumerable instances. 

The deaths are most numerous in proportion to 
the number of those attacked, at the commencement 
of the epidemic cholera, in a place where it has not 
before prevailed. This may be owing either to the 
greater violence of the disease at first, or to the want 
of care and proper treatment, which are always wit- 
nessed on the sudden invasion of a malignant epi- 
demic. 

It would seem however that the cause or causes 
that produce the disease are more violent at first ; 
and after a short time the disease is observed to be- 
come more mild and manageable. Remedies appear 
to have more control over it, and the hope is then 
entertained that the method of treatment adopted 
has lessened the mortality and triumphed over the 
disease ; and that if it was to recur it would be dis- 
armed of its terrors by the remedies which have at 
last been discovered. 

But all such hopes are sure to be blasted on a re- 
currence of the disease, or on trial of the same reme- 
dies in other places at the commencement of the 
epidemic. 

In Germany and France and in this country, ice 
and cold water have been administered, and frequent- 
ly with most happy effects, snatching the patient as 
it were, from the grave. 

But this remedy has also failed in innumerable in- 
stances; I have seen it administered, and have consi- 
derable confidence in it as a remedy, but I have also 
seen it of no further use than to afford a very shortlived 






THE CHOLERA. 137 



gratification to those whose only want when dying 
was to have their thirst assuaged, and whose 

" Burning mouth impel'd to crave 
One drop — the last— to cool it for the grave." 

Leeches* and cupping glasses, applied over the 
stomach and bowels, have many times proved service- 
able, especially in the early stage of the disease. 

Colchicum has also been given in this disease, and 
it is said with benefit. 

M. Coster of Paris, administered large quantities 
of oxygen gas to patients in cholera. A mixture of 
three fourths oxygen and one fourth atmospheric air* 
was the composition he made use of, and he says 
great relief was given in all cases, and many cures 
were effected by the use of it. Others have had re- 
course to it, and have not had like success. 

The nitrous oxyde gas or exhilarating gas has been 
administered in Europe and this country in cases of 
cholera, but I am not aware that it has been of ser- 
vice. 

M. Biett of Paris, administered with much bene- 
fit animal charcoal in cases of cholera ; this remedy 
has been greatly used by M. Recamier, at the Hotel 
Dieu, under the name of black magnesia. 

Owing to some analyses of the blood of patients 
affected with the cholera, and which showed a defi- 
ciency of the watery and albuminous portions, and 
also a deficiency of the muriate of soda and potassa, 
&c. injection of these ingredients into the veins has 
been resorted to, and several patients have apparent- 
ly been cured by this process 5 the particulars of 
which are detailed in another part of this work. 

But I will not further particularise the various re- 
medies that have been employed, to subdue this ma- 

12* 



138 TREATMENT OF 

lignant and terrific epidemic ; but proceed in accor- 
dance with the general plan of this work, to select 
from various and experienced authors in the different 
countries where the cholera has prevailed, some ac- 
count of the remedies they have used, and which 
they have found on trial to be beneficial. 

It has been exceedingly unfortunate, that in most 
of the countries where the cholera has prevailed, that 
some specific, or universal antidote for the disease 
has been sought for, as if the cholera was not only 
always of the same nature, but of the same degree of 
violence, affected the same organs and disturbed the 
same functions in all cases •, and in all cases required 
the same treatment. 

On this subject the following remarks from the 
New York Cholera Bulletin are deserving of consi- 
deration : 

" We are on debateable ground, with a host of 
champions to encounter, arrayed in various style, 
from the armories of ancient observation and modern 
experience. The profession is indeed in the field in 
motley garb to slaughter the monster of Epidemy ; 
but the members of it agree not on the mode of de- 
struction, and in the warmth of argument, and fury 
of debate, turn many of the weapons that should be 
directed against the enemy, towards their fellow 
" filii Esculapii." — Alas ! then, for the public, for 
whom Doctors and Cholera are contending ; they 
watch the fierce onslaught, and ever and anon are 
struck by the random blows that proceed from the 
combatants. Yes ! for ' Cholera kills, and Doctors 
slay, and every foe will have its way P 

Let us view the medical army ! In the foremost 






THE CHOLERA. 139 

rank stand the Bleeders, then advance the Calomel 
Band, escorted by a troop of Opium foragers ; here 
is a company of Stimulators, and there a Tobacco 
brigade ; here a file of Saline Aperients, and there 
again a guard of Leechers and Blisterers. The men 
of friction are in the van, and the rear is composed of 
the Icy legion. All these characters appear in the 
force raised to subdue the cholera, and by such a 
medley is the fell disease of Asia assailed. 

It may not be denied that in many instances, men 
are firmly wedded to an opinion, founded upon a suc- 
cessful report ; for instance, with few exceptions we 
know little of the nature of cholera upon this conti- 
nent, but what we have learnt from the writings of 
others in the situations where the demon malady 
yearly demanded a hecatomb for sacrifice ; it was 
therefore very natural that the fond enthusiast should 
lend his attention to the well told and promising tale, 
that after pourtraying the sad miseries of the disease, 
should describe its cure, and under circumstances 
that belied hope, and attracted disappointment ; of 
such tales there have been many, and surely there 
has been no want of listeners : the wildest theories 
have gained proselytes, the strangest romance has 
won a credence, and what has been wildly described, 
has been servilely imitated by the Physicians at a 
distance, who were thus improperly prepared to treat 
a pestilence, should it unfortunately visit the scene of 
their exertions. 

It is of course then said by some that the lancet 
will effect a cure, that calomel singly, or combined 
with opium is a specific ; that stimulants will restore 
the depressed, or tobacco will weaken the fiercest 
action ; that saline aperients will act successfully 



140 TREATMEMT OF 

through the circulation, that friction will stay the 
spasm, or that ice will moderate the accompanying 
fever. Now hovvever valuable all or any of these 
remedies may prove, if accepted exclusive of other 
treatment in every case, they will destroy more fre- 
quently than they can save : there are shades in cho- 
lera as in all other diseases— time for action is de- 
manded, time for repose is required: the available 
means suggested by medical skill are not invariable, 
either in the time or manner of their application, and 
however clearly the essentials of the disease may be 
evidenced, there are yet circumstances to be further- 
ed or modified, that attach an apparently new char- 
acter to it, and render the physician the servant in- 
stead of the controller of events. 

The remedies to which we have alluded have pro- 
bably cured many patients laboring under cholera ; 
in fact we have unquestionable testimony from the 
physicians in India and Europe of their value — what 
objection then can be raised to their employment ? 
None but their indiscriminate use ! If, as is surely 
the fact, scarcely two persons have suffered in chole- 
ra under the same identical symptoms, as if in addi- 
tion, what is as surely true, that no two systems ever 
exactly corresponded in power or peculiarity, each 
attempt to bring a variety of cases within the same 
remedial treatment is likely to be as injurious to the 
patients as it is absolutely ridiculous on the part of 
the practitioners. We have heard that some medi- 
cal men regard cholera in one light, and some in 
another: with one it is simply a " disease of excite- 
ment,' 1 with a second, it is marked by congestion in 
its earliest stage, and with a third, the nervous func- 
tion is primarily attacked, rapidly inducing a cessa- 



THE CHOLERA, 141 

tion of the accustomed secretions. As one of these 
causes is always considered in operation, one plan of 
treatment is as regularly brought into play : a hot 
skin, a frequent and bounding pulse, a coated tongue, 
the utmost anxiety and restlessness, are regarded and 
treated the same, as when a cold surface, a w r eak and 
tremulous pulse, a chilled tongue, and a state of co- 
ma are apparent : whatever the theory may be, the 
practice is the same in various stages and degrees, 
sometimes perhaps to the salvation, sometimes, alas ! 
to the destruction of the patient. We have moreover 
heard of confusion between the states of congestion 
in its most considerable extent, and exhaustion in its 
lowest condition, when stimulants and sedatives 
have exchanged the places they were intended to 
fill. 

Is there then a difficulty in the treatment of chole- 
ra ? We think not ! A close observance of prevail- 
ing symptoms will ever tell to the intelligent physi- 
cian the amount of danger, and the quarter in which 
it may be apprehended : whether the danger be gene- 
ral or local (for these distinctions may with propriety 
be drawn,) there are means within his power for their 
abatement, in the majority of cases where his aid is 
promptly demanded : such a physician will advance 
to the bed side of his patient with a mind w r ell stored 
with the observations of others on the character of 
the disease, but yet untrameled by any specious rea- 
sonings : he will investigate, as far as may be, the 
history of his case, and endeavor to detect the cause 
and the attendant circumstances of its appearance. 
Gifted with sound common sense, that rare but ines- 
timable quality, and possessed of a corresponding 
medical knowledge, he applies the resources at his 



142 TREATMENT OF 

command according to the necessity existing, and 
triumphs when many fail, and only fails when none ; 
may triumph. 

Without refraining from the use of each recom- 
mended measure, when prudence demands its em- 
ployment, he yet avoids its abuse, and wisely selects 
from the experience of others, that which confirms 
his own. 

We may therefore regard cholera in the same point 
of view as any other disease ; it is almost needless to 
pronounce it specific in its character, for what disease 
is not ? And it therefore becomes the physician to 
conduct himself in the treatment of cholera as in oth- 
er maladies, where symptoms are watched and aba- 
ted, and where each remedy is proposed with a ra- 
tional expectation of success, so far as medicine can 
ensure an auspicious result. 

The lancet therefore is useful ; so is calomel, opi- 
um, tobacco, with the whole of the list so frequently 
talked of, and so frequently admitted in practice ; the 
sole difficulty is when to direct their power against 
one of the fiercest diseases that has ever oppressed 
mankind, and this is a difficulty that must be submit* 
ted to professional skill for solution.' 5 



TREATMENT OF THE EPIDEMIC CHOLERA IN INDIA, 

One of the earliest accounts we have of this dis- 
ease is contained in a letter from Frederick Corbyn* 
Esq. assistant surgeon in the Bengal establishment, 
to Sir Gilbert Blane, Bart, physician to the King of 
England. This letter is dated at Sauger, September 
?th, 1819, and the following remarks respecting the 



THE CHOLERA. 143 

treatment of the cholera are extracted from that let- 
ter, as published in the Medico Chirurgical Transac- 
tions for 1820. After describing the progress and 
symptoms of the disease, Mr. Corby n says, 

" It now affords me particular pleasure, as it will 
be highly gratifying to you, to turn from the melan- 
choly scene I have just described, and inform you 
that the treatment I have hitherto followed, and 
which the Marquis of Hastings, whose great anxiety 
on the subject cannot be enough admired and com- 
mended, did me the honor to have published in gen- 
eral orders and circulated in the army throughout In- 
dia, has proved eminently successful. I shall now 
quote the authority of others for the excellence of the 
remedies which I found so decidedly and invariably 
successful in my own practice, and it is grati- 
fying to me to reflect, that through the promul- 
gation and general adoption of them, an incalculable 
number of lives has been saved. 

The outline of the treatment alluded to, is, to ad- 
minister twenty grains of calomel (in powder., not in 
pills) and to wash it down with sixty drops of lauda- 
num, and twenty drops of oil of peppermint in two 
ounces of water, to bleed freely in the early stage, and 
to support the warmth by external heat, the hot bath 
and hot friction, and internally by cordials. 

The first report is dated Seroor, the 22d of July, 
1818, by Mr. Assistant Surgeon Wallace. He re- 
marks, ' The disease is most formidable. We have 
found the large doses of calomel, oil of peppermint 
and laudanum, generally succeed in checking the 
purging and vomiting. But the most formidable symp- 
toms are the sudden debility and coldness, which 
seem to indicate the use of the most powerful stimu- 



14 4 TREATMENT OF 

lants. The hot bath has been found very useful.' 
This gentleman's third report states as follows ; ' I 
believe Mr. Corbyn's practice to be very efficacious 
when adopted early. The majority of cases did not 
apply for relief until they had been attacked for some 
hours, and the medicines were almost invariably re- 
jected in common with every other liquid. I deter- 
mined to administer the medicine in another form, 
and rubbed up tw 7 o grains of soft opium, with fifteen 
grains of calomel, and about two drachms of honey. 
This was gradually swallowed, being dropt into the 
patient's mouth by the finger. After this he was pla- 
ced in the hot bath, and small quantities of hot arrack 
and water mixed with spices and sugar given to drink. 
The patient commonly fell asleep, and in favorable 
cases, awoke free from danger. In others, the cold- 
ness and spasms recurred, when recourse was again 
had to the hot bath, and opium administered in vari- 
ous forms. Twenty-two cases only were admitted 
yesterday, and all of them except two have recover- 
ed.' 

Dr. G. Burrill, surgeon of the 65th regiment, dates 
his report at Seroor, 27th July, 1818, and makes the 
following return. It broke out on the 18th inst. 



Admitted 21st 


1 


22d 


6 


23d 


6 


24th 


18 


25th 


22 


26th 


7 



60 Died, 4. 



THE CHOLERA. 145 

< On admission, I bled in every instance, in gene- 
ral, to a good extent. Where universal spasm exist- 
ed, venesection was carried ad deliquium, and the pa- 
tient was at the same time put into a hot bath of 110°. 
The spasms were, by these means, invariably reliev- 
ed, nausea and vomiting alleviated, so that the stom- 
ach bore the exhibition of calomel in scruple doses, 
combined with laudanum, which doses were fre- 
quently repeated ; in short, the opium was given un- 
der every denomination, with calomel, and 1 believe 
the calomel will be found to rest on most stomachs 
per se. 

The next report is from Mr. Surgeon Whyte, da- 
ted Seroor, the 28th of July, 1818. He states, ' The 
practice 1 had followed was that first recommended 
by Johnson*, and since by Mr. Corbyn, in which 
the corner stone and sheet anchor is calomel, in a 
dose of fifteen or twenty grains of the former, to an 
adult, according to his strength.' 

We now come to that of Mr. Assistant Surgeon 
Daws. His letter is directed to Dr. Jukes at Tan- 
nah, dated at Aurangabad, 2^th of July, 1818. He 
remarks as follows : ' I presume you have seen the 
letter written by Mr. Corbyn, who had charge of 
the Native Hospital, centre division of the army, at 
Eritch, to Captain Franklyn, Assistant Quarter 
Master General of the same division. On this sub- 
ject I could not perhaps do better than recommend 
you to pursue the plan of treatment therein laid down, 
as it is the same, with very little variation, that 1 have 

* In his work on the influence of tropical climates on European 
constitutions, where he quotes the case of a seaman who had swallow- 
ed a scruple of calomel. 

13 



146 TREATMENT OF 

adopted, and you will be glad to hear that the suc- 
cess of my own practice tends to corroborate it.' 

The next report is from Mr. Surgeon Craw, dated 
Seroor, 30th July, 1818. He observes; c The calo- 
mel and laudanum plan, with most diffusible stimuli, 
and the hot bath, have been eminently successful ; 
and if application is made within four or six hours 
from the first appearance of the disease, the cure is 
almost certainly effected.' In another place he re- 
marks, that a bleeding quoad vires, the calomel and 
opiate, the hot bath, warm clothing, and frictions, 
spiritous or anodyne, form the chain of treatment in 
the European Hospitals here, and these are repeated 
again and again as the symptoms may seem to de- 
mand. Under this plan, and an early application 
for relief, 1 think the disease is not fatal in more than 
one in a hundred cases. The following report is from 
Assistant Surgeon Campbell of the 22d dragoons, 
dated from Seroor. ' The scruple dose of calomel 
with Corbyn's anodyne draught was given every two 
hours, but when the spasms and vomiting had ceased, 
the laudanum was omitted, the calomel continued, 
and the stimulants more frequently given.' 

The next report is from Mr. Assistant Surgeon 
Tod, dated Camp Chumargoody, Aug. 8, 1818. ' The 
way I have administered medicine is by giving calo- 
mel, one scruple, and washing it down with tinctura 
opii, one drachm, and water, two ounces, and repeat- 
ing them after an hour, if the first dose is rejected. 1 
have sometimes left the interval of an hour, which 
generally succeeds ; but 1 have, in a few instances, 
been under the necessity of giving it three or four 
times.' In another place, this gentleman adds,'! 
have had altogether an hundred cases w 7 here the cal- 



THE CHOLERA. 147 

orael and opium plan has been followed, and though 
ten or twelve have died, these were either such aged 
subjects that no rational hope of recovery could be en- 
tertained, or were brought in at such an advanced 
stage of the complaint, as to be beyond the power- of 
medicine. 5 

Mr. Assistant Surgeon Milwood writes the next re- 
port, which is dated Ahmednugger, 2d August, 1318. 
'I will now give my treatment, with my reason for 
the addition I have made to Mr. Corbyn's. There 
are two great objects to be attained for the recovery 
of the patient. 1st, to allay the vomiting and pur- 
ging ; — 2ndly, to restore the pulse and heat of the 
extremities and produce sleep. In order to effect 
these, I have, in addition to one scruple of calomel, 
put five grains of antimonial powder, and added to 
the draught one drachm of spt. aether, nitros. In the 
course of two hours, I give ten grains of calomel and 
five of antimonial powder, with half the draught 
which 1 prepare with camphor mixture, in place of 
plain water, and repeat this as it is required. The 
best laxative I have found to be carbonate of mag- 
nesia, four scruples. It remains on the stomach, and 
generally causes two or three plentiful evacuations.' 

Mr. Assistant Surgeon Richards reports as follows. 
Punderpoor, 3d of August, 1818. ' Up to this morning 
the admissions amount to 170; out of which eight 
casualties have occurred.' This gentleman bled and 
used the calomel and laudanum doses. 

To evince how essentially necessary bleeding is, Dr. 
Burrell sends the following return : — 



148 TREATMENT OF 

Bled 88 Died 2 

Not bled 12 " 8 

Total admitted, 100 Died 10 

I now come to Mr. Surgeon Longdill's report, da- 
ted Seroor, 17th of August, 1818. 'My general plan 
of treatment was to give the dose recommended by 
Mr. Corbyn. If it was rejected, another was given, 
after waiting an hour, with the warm bath, which 
generally relieves the patients ; after which they re- 
quired little else but cordials and a gentle laxa- 
tive.' 

Mr. Surgeon Robertson, of the European Regi- 
ment, on the Bombay establishment, dates his report 
from Keerky, and states that bleeding relieved them, 
and that calomel and opium brought them quite 
round. 

The report which succeeds is from Mr. Surgeon 
Gordon, dated Satara, 5th September, 1818. 'I sent 
you a report in which I stated that I laid considera- 
ble stress on free and early blood-letting. Since 
then, 1 have had eleven cases, bled the whole of them, 
then opened the bowels, and they are all quite well."' 

Mr. Surgeon Coats reports to the President of the 
Medical Board, that ' the practice followed in the 
medical treatment of this disease at Aurangabad was 
that recommended by Mr. Corbyn, and had been 
particularly successful ; indeed, if the patient applied 
in time, it was considered as infallible.' 

Mr. Surgeon Jukes next reports, that £ experience 
has now taught us that a very large proportion of 
those attacked by the disease, recover by the calo- 
mel and laudanum alone; but I feel satisfied that 
there are many aggravated cases wherein nothing but 



THE CHOLERA. 149 

the most prompt and decided use of the lancet could 
possibly save the patient.' 

The next report comes from Dr. Taylor, a gentle- 
man who had the principal practice in the disease at 
Bombay. This practice is precisely similar to the 
foregoing ; he gives the following return : — 

Medicine administered to 7,459 

Of whom died 441 

being a proportion of nearly six to an hundred. 

The last report is from Geo. Ogilvy, Esq. Secretary, 
to the Medical Board, confirming the treatment al- 
ready mentioned, and the reports are concluded with 
the following abstract of cases which occurred in the 



island of Bombay. 






1817. 


Cases. 


Deaths 


August 


4400 


456 


September 


4804 


287 


October 


2411 


146 


November 


824 


44 


December 


806 


64 


1819. 






January 


889 


114 


February 


517 


27 



14651 1138 

Proportion of deaths in those cases in which medi- 
cine was administered, 6.6 per cent. In the same 
space of time 1294 cases were reported by the police, 
in none of which, medicine was administered, and it 
is a most important remark by Mr. Ogilvy, Secretary 
to the Medical Board, that it was not ascertained 
13* 



150 TREATMENT OF 

that any case had recovered in which medicine had not 
been administered. 

The population may amount to between 200,000 
and 220,000. The number of ascertained cases was 
15,945, which gives the proportion of the attacks of 
the disease to the population, 1\ per cent. 

I believe 1 have now satisfactorily proved to you 
the efficacy of the treatment 1 recommended. 1 
shall add the remarks of the Medical Board of Bom- 
bay, made after summing up the whole of the opin- 
ions regarding the proper mode of treatment to be 
adopted. 

4 On the subject of the cure of the disease, we need 
say but little. The practice so j udiciously and speed- 
ily adopted by Dr. Burrell in the 65th regiment, clear- 
ly proves, that in the commencement of the disease 
in Europeans, blood-letting is the sheet-anchor of 
successful practice, and perhaps also with the natives ; 
in this 1 have entirely concurred in my printed report, 
but have there said nothing of this practice among the 
natives. I tried bleeding with the natives, but could 
get no blood from the arm, and finding every efficacy 
from the medicine 1 prescribed, I had no occasion to 
make a second attempt ; but I have no doubt you 
will perceive, from the principles on which I ground 
the cure, that the venesection is advisable in all cases 
where blood can be obtained ;' to proceed — ' provi- 
ded it can be had recourse to, sufficiently early in the 
disease, and as long as the vital powers remain so as 
to be able to produce a full stream, it ought never to 
be neglected, it being sufficiently proved that the de- 
bility so much complained of, is merely apparent. 
Calomel as a remedy certainly comes next in order, 
and when employed in proper doses with the assist- 



THE CHOLERA. 151 

ance of opium, more particularly in the early stage of 
the disease, seems to be equally effectual among the 
natives, as venesection among the Europeans, in ar- 
resting its progress. In all the cases formerly alluded 
to, when we met with the disease in its first attack, a 
single scruple of calomel with 60 minims of laudanum, 
and an ounce of castor oil seven or eight hours after- 
wards, was sufficient to complete the cure. The 
practice of this place, as sufficiently appears from 
Dr. Taylor's report, bears ample testimony to the 
control which calomel possesses over this disease. 
All other remedies must in our opinion be considered 
as mere auxiliaries, no doubt extremely useful as 
such, and ought never to be neglected, particularly 
the warm bath and stimulating frictions.' 

I trust, Sir, I have now performed my duty in giv- 
ing you a full and accurate account of the nature and 
treatment of this alarming epidemic. I am still ac- 
cumulating information, but in the mean time, as my 
object is utility and not emolument, I beg you will 
give publicity to this letter, by procuring the insertion 
of it in that excellent work, the Transactions of the 
Medico-Chirurgical Society. 

I am, my dear Sir, 
Your very obedient Servant, 

Frederick Coubyn. 

To Sir Gilbert Blane, Bart." 

Several years after the above was written, the 
Madras Medical Board published an account of the 
epidemic cholera, as it appeared in the territories sub- 
ject to the Presidency of Fort St. George, 

This report was drawn up by William Scot, sur- 
geon and secretary to the Board, and the following 



152 TREATMENT OF 

remarks respecting the treatment of the disease are 
extracted from that report. The accompanying re- 
marks are from the Medico Chirurgical Review for 

1825. 

" In no disease has the sovereign efficacy of nu- 
merous specifics been more vaunted — in none have 
they been more frequently inefficient, than in chole- 
ra. While the general tendency of the disease was 
almost invariably towards a fatal termination, there 
was yet a certain stage, at which its progress might, 
in very many instances, be arrested by the most op- 
posite, and sometimes by the most trifling remedies. 
The earliest movements in cholera, especially as it 
first manifested itself, were generally confined to irri- 
tation of the stomach and bowels — ; and in this stage 
it is unquestionable that the mere exhibition of an 
anodyne, a cordial, or an antispasmodic medicine 
was sufficient, in numberless instances, to stop the 
progress of the disease, and to effect a cure.' After 
the first epidemic sweep, however, of the cholera, it 
was universally acknowledged by practitioners, that 
the remedies so successful in their former practice, 
were almost totally unavailing in the subsequent visi- 
tations. 

Opium. JNo medicine has been so universally 
used as this, and none, perhaps, has so generally re- 
tained its reputation. It was more successful, how- 
ever, among the natives than among the Europeans, 
from their greater susceptibility to the action of medi- 
cines. 

' While, as an anodyne and antispasmodic, the 
efficacy of opium in the cure of cholera has been pro- 
ved by experience to be great, it is painful to be 



THE CHOLERA. 153 

obliged to acknowledge, that in many apparently 
promising cases, where even its narcotic effect was 
evident, it had no ultimate effect in warding off a fa- 
tal termination ; and in the advanced stages of the 
disease, whether it was first exhibited at that period, 
or whether its use may have been begun earlier, and 
then continued, its efficacy in restoring the depressed 
or suspended functions, like that of all other remedies, 
is extremely uncertain. Those cases may, with 
most confidence, be chiefly trusted to the effect of 
opium, in which the primary symptoms are seated, 
apparently, in the stomach, as indicated by vomiting, 
and spasmodic pain in that region ; and in the intes- 
tines, as indicated by violent purging, and painful 
contractions of the abdomen. Its effects are more 
uncertain, where the affection of the stomach is ob- 
scure ; where there is a moderate, but insidious purg- 
ing ; where there is great sense of heat in the epigas- 
trium, and in every case where collapse has come 
on.' lv. 

Passing over aether, ammonia, spirits, wine, and 
other diffusible stimuli, we come to— 

Calomel This was almost as universally given as 
opium, and as indiscriminately. It was administered 
for various indications, and with various views, ac- 
cording to the practitioner's opinions respecting the 
nature of the disease. Mr. Scot does not appear to 
be favorable, on the whole, to the administration of 
calomel, at least in the early stage of cholera. 

' The success of those practitioners, who did not 
use calomel in the primary treatment of cholera, 
has been fully as great as that of those who did : 
while the arguments, distinctly brought forward by 
various medical officers against its early exhibition^ 



154 TREATMENT OF 

appear decisive against the observations which have 
been offered in support of the practice. Calomel has 
unquestionably a powerful effect in exciting the bilia- 
ry system, and in this view, its exhibition is highly 
necessary : but the suppression of the excretion of 
bile being only a link in the common chain of symp- 
toms, and its partial, or occasional removal, or even 
its total absence, having been proved to be of little 
consequence in the general course of the disease, to 
attempt to excite it by particular means, may be con- 
sidered as premature and injudicious. Whenever a 
favorable change takes place, indicated by a renew- 
al of the ordinary functions, then the exhibition of 
the appropriate stimulus seems to be clearly indica- 
ted, and not till then.' Ivii. 

Blood-letting. This remedy was first proposed by 
the editor of this Journal, from observing its effects in 
one or two sporadic cases of cholera in the island of 
Ceylon, more than twenty years ago. It will be seen, 
from the following extract, that it has been an im- 
portant measure of late, in the treatment of this ter- 
rific malady. 

' The abstraction of blood, unless as an anti-spas- 
modic, is a remedy so little indicated by the usual 
symptoms of cholera, that its employment in the cure 
of this fatal disease has afforded a signal triumph to 
the medical art. It requires no common effort of rea- 
soning or reflection to arrive at the conclusion, that, 
when the powers of life appear depressed to the low- 
est degree, the pulsation of the heart all but extinct, 
the natural heat of the body gone, and the functions 
of the system suspended and incapable of being re- 
vived by the strongest stimulants, the abstraction of 
blood might yet prove a remedy against a train of 



THE CHOLERA. 155 

symptoms so desperate. Bleeding was, no doubt, 
first employed in cases where there was much 
spasm, and where the powers of the system had not 
much declined : the relief was generally obvious and 
immediate, and the practice in such instances was 
thus established. Dissections having frequently 
shown a loaded state of the vessels of the viscera, 
and apparent inflammation of their mucous mem- 
branes, venesection was also adopted to obviate 
these conditions, and naturally enough : but the em- 
ployment of blood-letting, without reference to either 
of these states, and as a remedy for collapse in chole- 
ra, must have been the result of reasoning and reflec- 
tion, founded on the general principles of the science ; 
a result highly honorable to the profession ; and, as 
we shall endeavor to show, of the utmost practical 
importance in the cure of the disease. 

' We have no precise information regarding the 
manner in which venesection was performed in 
general ; although, in such a disease, this seems a 
matter of very considerable consequence. It is re- 
markable, that in a disease like cholera, syncope 
should be so rare a symptom. W hen it is brought on 
by venesection, it is generally favorable, which may 
most probably be imputed to its being employed dur- 
ing violent spasm, and before any sinking has taken 
place. We can then readily understand, that the 
free evacuations of blood, which may be supposed to 
precede the syncope, as well as that state of relaxa- 
tion itself, will be followed by amendment : but there 
is no information, which can lead us to believe, that 
syncope has often followed the abstraction of small 
quantities of blood, or that success had followed 
small bleedings. The usual expression is, that after 



156 TREATMENT OF 

a scanty discharge of blood, it ceased to flow, and 
that depression of pulse, with faintness, not syncope, 
came on, or was increased. We are not informed, 
whether bleeding has been generally performed in the 
recumbent, or half erect posture. It is evident from 
the reports, that the mere act of elevating the body 
has been followed by faintness and even death : and 
if venesection has been often attempted in the half 
erect posture, we may thence account in some mea- 
sure, for the frequent want of success in obtaining 
blood. 

' Few remedies, on a fair trial, have been more 
generally and unequivocally advocated than free 
blood-letting; and the most that has been urged 
against it is, that it is not always successful. The 
advocates for bleeding proceed, however, on the prin- 
ciple, that a certain quantity of blood is to be obtain- 
ed, in order to ensure success, which few of them 
estimate at less than about 30 ounces. Those who 
are disposed, either less favorably towards bleeding, 
or to condemn it altogether, object, that if the circu- 
lation is in a condition to admit of free bleeding, the 
case is a mild or favorable one, and would probably 
yield to other remedies. There is no doubt, that fa- 
tal collapse has sometimes suddenly followed, even 
large bleedings, which has staggered the faith of 
many practitioners in the general safety of the reme- 
dy; but in the great majority of cases, it is after small 
bleedings that this has happened. There is the most 
ample evidence also, that cases, especially in Eu- 
ropeans, even under the most favorable appearances, 
will often, in spite of all internal and external reme- 
dies, go on to a fatal issue, when bleeding is not prac- 
tised. 



THE CHOLERA. 157 

* The cause of collapse coming on after, or during 
bleeding, in cases of cholera, may perhaps be ex- 
plained, so as to obviate the objections thence arising 
against it as a remedy in that disease. It seems un- 
questionable, that the evacuation of a small portion 
of blood, such for instance, as we might suppose to 
be yielded by the remoter branches of vessels, is fol- 
lowed by increased debility : but if we succeed in 
carrying on evacuation, till its effects reach the inter- 
nal vessels and the heart itself, then the circulating 
system seems to be freed from an oppression which 
impeded its functions, and it becomes equal to the 
task of propelling the mass of blood. This is a species 
of indirect excitement. The powers are not raised, 
but the resistance, or weight, is lessened. Such is the 
theory, which has been adduced in support of blood- 
letting in cholera. The reader will be aware, that it 
is not new ; its application to the* particular disease, 
of which we are now treating, being the only novel- 
ty • If the theory be true, the presence or the superven- 
tion oj collapse, so Jar from, deterring us from going on, 
should only be regarded as additional reasons for re- 
newing our efforts to get bloods 

In proof of this, a great many testimonies are 
brought forward drawn from the journals of medical 
officers, after which Mr. Scot goes on thus : — 

1 Besides the very ample evidence, which will be 
found in the printed reports, in favor of blood-letting 
as a remedy in cholera, the opinions of the majority 
of medical officers whose observations are not insert- 
ed, are also decidedly in its favor. The objection 
chiefly urged, is not against the practice, but rests on 
the too frequent impracticability of procuring a suffi- 
cient quantity of blood. It is acknowledged, even by 



158 TREATMENT OF 

the most zealous of its advocates, that this difficulty has 
often occurred, and proved insuperable. When, how- 
ever, the operation is performed with the moral con- 
viction, that, if successful in obtaining blood, the life 
of the patient will most probably be saved, the opera- 
tor will presevere, undiscouraged, in his efforts : he 
will call in every suitable aid, such as frictions, bath- 
ing the arm in hot water, re-opening the orifices of 
the vessels, administering stimulants, and external 
warmth. He is not deterred and induced to desist 
by any intermediate accession of debility, or collapse; 
nor, is he tempted to rest satisfied with any tempora- 
ry melioration of pulse ; his object goes beyond the 
present moment, and he feels satisfied, that if he can 
fuliy unload the internal vessels, he will save his pa- 
tient, and if he fails, that he will most probably lose 
him. It is not considered to be of much importance 
whether the patient may have been bled before or not, 
if his present symptoms indicate a repetition of the 
operation. The principle is, that collapse, in cholera, 
is not the consequence of the loss of blood, but is a 
condition which nothing but its abstraction can be 
trusted to for relieving. In the second case, however, 
when the medical man is not decided in his own 
mind, obstacles will be allowed to subdue his forti- 
tude, and arguments will be then deduced to dissuade 
him from perseverance. A sudden aggravation of 
the symptoms of collapse will be regarded as an ef- 
fect of a remedy, at least doubtful; or, a transient 
return of vascular action will be held, either as a 
sufficient advantage gained, or as an indication that 
bleeding is no longer required. It is thus we may 
account for a vast number of ineffectual, because un- 
decided attempts at blood-letting; and for avast 



THE CHOLERA. 159 

number of unsuccessful results, when the quantity 
abstracted falls short of that which is required : for 
the volume of the blood must be reduced in a given 
proportion, in order to secure the effects expected 
from it. Any thing short of this will only take away 
from the patient's strength, and not augment the mo- 
tive powers of the circulating system ; or what is the 
same thing, will not diminish the resistance to the 
motive powers. 

' Cholera is unquestionably a very dangerous dis- 
ease, and so many circumstances concur in aggrava- 
tion of its natural fatality, that we can scarcely hope 
that any mode of treatment will ever be devised 
which shall strip it of its formidable character. Much 
injury has arisen, however, from remedies being 
brought forward, and tried, as if they were absolute- 
ly specific and infallible. And amongst others, blood- 
letting has been put to this most unjust, and unphi- 
losophical test. If strictly considered, it would, 
perhaps, be the least of all entitled to the appellation 
of a specific remedy ; for in truth, there is great rea- 
son to doubt, whether it be directly curative of the 
essential symptoms of cholera. Its warmest advo- 
cates only consider it as an auxiliary, and never trust 
to it, but in combination with other, and which indeed 
appear to be, the strictly appropriate remedies. Con- 
gestion, for which alone it is indicated, appears mere- 
ly to be a symptom or consequence of that morbid 
state, which forms the first and highest link in the 
train of cholera actions. The removal of congestion, 
which is mechanical, allows the heart to respond to 
the action of the other remedies. Should it be ob- 
jected, from a consideration of some dissections, that 
no particular congestion has taken place, the blood 



160 TREATMENT OF 

appearing to be equally diffused over the vascular 
system ; and that in some instances, the circulation, 
though ultimately affected, seems to retain its powers 
for a time, without material depression, yet, even in 
such cases, venesection, by lessening the volume of 
the blood, may still have beneficial effects. We 
should certainly apprehend no danger from it in cases 
of this description, used, as it ought invariably to be 7 
in conjunction with the other remedies.'* lxi. 

These other remedies were principally antispas- 
modics and stimulants. Of the various means, in- 
ternal and external, not yet enumerated, it is quite 
unnecessary to speak. Hot applications to the skin 
had far less effect than might have been expected, 
from the deadly coldness of the surface, and torpid 
state of the extreme vessels." 

Mr. James Annesley, of the Madras Medical 
Establishment, and Surgeon of the Garrison and 
General Hospital, Madras, published in 1825, a 
Treatise on the epidemic cholera of the East, from 
which the following remarks respecting the treatment 
of the disease are taken : 

" The following is the way in which this disease 
has usually been treated under my direction : — 

A patient is admitted into the hospital, I shall say 
at noon, with all the symptoms of cholera; a vein is 
immediately opened, and one scruple of calomel and 
two grains of opium are given in the form of a pill, and 
washed down with the camphor draught. The body 
and extremities are well rubbed with dry flannels, 
made warm, and bottles filled with hot water are ap- 
plied to the feet and hands; but if the spasms are 
severe, spirits of turpentine are used as an embroca- 



THE CHOLERA. 161 

tion. In an hour, we generally perceive the effects 
of these remedies, and whether the disease be in any 
degree arrested, or be proceeding in its progress. If 
the former, riothing more is to be done till evening, 
when the calomel pill may be repeated, and an end- 
ma exhibited. The following morning the bowels 
should be again fully evacuated, and then the patient 
may be considered safe. 

When blood, however, cannot be drawn from the 
arm, and the spasms continue ; when severe pain and 
burning heat are felt at the umbilicus and scrobicu- 
lus cordis, and are distressing ; when the skin is cold, 
and deluged with cold clammy dew ; and when there 
are oppression in the chest and difficulty of breathing 
-—excessive pain and confusion about the head, with 
great intolerance of light — no pulse, or a pulse scarce- 
ly to be felt, and a cadaverous smell from the body, 
twenty or thirty leeches should be applied immediate- 
ly to the umbilicus and scrobiculus cordis ; the calo- 
mel pill should be repeated, and the turpentine em- 
brocations continued. Leeches ought likewise to be 
applied to the temples and base of the scull. 

When the leeches bleed freely, the application of 
them is always attended with decided advantage, and 
they should be allowed to remain till they have ful- 
filled their duty ; after which, a large blister or sina- 
pism should be applied over the whole abdomen. 
Sometimes the leeches fasten, but do not draw blood. 
In this case, they should be removed immediately, and 
the sinapism or blister applied in their place. When 
the bowels are very irritable, and constantly discharg- 
ing a watery fluid, small anodyne enemas, with cam- 
phor, may be given ; and the drogue amere, a nos- 
trum used by the Jesuits, will be then found very use- 

14* 



162 TREATMENT OF 

ful in assisting the operation of calomel, which latter 
should always be repeated every two hours, till three 
or four scruples have been taken* 

Whenever we fail in checking the disease at first* 
we have no resource but to treat urgent symptoms, 
and they must always be met with decision as they 
occur. The patient ought never to be left a moment 
without an attendant who is capable of acting ac- 
cording to circumstances, and who may take advan- 
tage of every change." 

The cholera appeared at Port Louis, Mauritius, in 
1819 and 1820, and the following account of the 
treatment adopted at that place, is taken from a com- 
munication by Dr. Kinnis, published in the Edin- 
burgh Medical and Surgical Journal for 1821, 

" In the fatal form of the disease, the chief reme- 
dies employed, were bloodletting, the warm bath, 
spirituous and dry frictions, rubefacients, the internal 
exhibition of spirits, opium, calomel, Epsom salts, 
and other purgatives. The extraordinary success of 
Mr. Sheppard, in treating a similar disease by blood- 
letting to syncope, as reported in Dr. Johnson's work 
on tropical climates, induced me to practice it on 
the two first patients attacked ; but from neither of 
them, though veins were opened in each arm, could 
more than twelve ounces of uncommonly dark blood 
be obtained. Mr. Markham tried it with no better 
success in two other cases. It was also tried, as we 
have seen, in some of the less violent affections ; and, 
the impression produced on me by the whole is, that 
when only a few ounces can be obtained, their ab- 
straction accelerates the fatal event, and when blood- 



THE CHOliERA. 163 

letting can be carried to syncope, the disease is cura- 
ble without it. 

Opium seemed, in many cases, to prevent the ac- 
tion of other remedies, by causing a torpor of the in- 
testines ; and the warm bath contributed to the same 
effect, by diverting the fluids to the external surface. 
The first, 1 think, ought never to be exhibited after 
vomiting has ceased ; nor the second, unless the skin 
is dry and the cramps very severe* 

The cold arising from their evaporation, appeared 
to counteract the stimulant effects of the spirits em- 
ployed in friction ; they were soon dropped altogeth- 
er, and warm flannels substituted, particularly during 
the spasmodic paroxysm, but friction of no descrip- 
tion ever obviously contributed to restore the natural 
warmth. Cataplasms of mustard, garlic, and capsi- 
cum, beat up into a mass, with spirits of hartshorn 
and vinegar, were suggested by Dr. Burke, and some- 
times applied to the prsecordia and extremities ; but 
in one case only produced the smallest rubefacient 
effect. 

At the commencement of the disease, spirits were 
very liberally administered, both in the form of 
draught and enema ; most of the patients swallowed 
them with great reluctance, and rejected them im- 
mediately, even when combined with tincture of 
opium. 

Though aware that calomel had been recommend- 
ed in the cholera of India, the astonishing rapidity of 
its course prevented me from thinking of that medi- 
cine in the two first cases that occurred. Observing, 
however, that bile was absent in the egesta and in 
the alimentary canal of every patient 1 had seen ; that 
one man, after overcoming the first symptoms, passed 



164 TREATMENT OF 

nothing else ; and lastly, that every other remedy had 
turned out either useless or prejudicial, I resolved to 
try calomel, and to throw it in with a precipitance 
which the nature of the disease seemed to justify, in 
the unhappy case already detailed. That patient 
was considered convalescent on the 6th December ; 
and before the 14th of the same month, when the san- 
guine expectations 1 had been led to entertain of his 
recovery were exchanged for the bitter certainty of 
his approaching dissolution, five other cases had been 
admitted, and treated nearly in the same way. Two 
only were salivated and recovered ; but one of these, 
alluded to in describing the symptoms, shared the fate 
of poor Reed, and died on the 1 2th day. The other 
took twelve scruples of calomel, of which probably a 
considerable quantity was vomited ; his ptyalism was 
by no means severe ; and he was discharged nine 
days after admission. 

From all I had seen of the symptoms, and all I 
could find on dissection, it now appeared to me that 
mercury was the only known remedy on which any 
dependence could be placed ; at the same time, that 
I had lamentably mistaken the proper mode of intro- 
ducing it into the system. Instead of a scruple eve- 
ry two hours, 1 now gave that quantity on admission, 
and repeated it as often as rejected by vomiting ; 
when one scruple had been retained, five grains were 
given every hour. Out of six cases, treated on this 
plan, two recovered, though in neither of them the 
mouth became affected. 

The renewal of the secretion of bile, which is evi- 
dently suspended in this disease, I consider to be our 
grand object in the treatment; but the safest and 
most speedy method of accomplishing that object, 






THE CHOLERA. 165 



when it is possible, my limited experience does not 
enable me to point out. 

Another desideratum in the treatment, is a method 
of suppressing vomiting, that would not interfere with 
the action of other remedies. Opium, calomel, and 
sulphuric acid, separately or combined, are inadequate 
to this effect ; abstinence from liquid ingesta might 
perhaps answer, if one patient in twenty could sub- 
mit to the torture of that privation. 

Purgatives were generally exhibited by enema, 
soon after admission, and by draught, the moment 
there was any probability of their being retained. 
Sulphate of magnesia and the infusion of senna were 
preferred ; but the cathartic tinctures, also, were very 
frequently administered in the form of enema. 

Sometimes, immediately after recovery, the evacu- 
ations consisted of a deep grass-green fluid, of the con- 
sistence of a thin jelly. 

Of the multiform, but less severe varieties, which 
the epidemic assumed, the simplicity of the treatment 
was only authorized by its unvarying success. Ten 
grains of calomel, or, when the vomiting was severe, 
a scruple, followed, at the distance of some hours, by 
an ounce of salts, with or without infusion of senna, 
and once or twice repeated, cured almost every case, 
Most of the instances, in which blood-letting was re- 
sorted to, have been given at length ; we have seen 
that it seldom produced any decided relief until the 
bowels had been freely opened ; and I am inclined to 
think it might always have been very safely dis- 
pensed with. When considerable debility and ano- 
rexia survived all the other symptoms, the patient 
used to be brought round, in a few days, by one of 



166 TREATMENT OF 

the bitter infusions, mixed with a small proportion of 
the compound tincture of bark." 



TREATMENT OF THE CHOLERA IN EUROPE. 

When this disease first appeared in Europe, re- 
course was had to the publications from India, not 
only for an account of the disease, but for the treat- 
ment of it. And upon examination, we find nearly 
the same remedies have been employed in all coun- 
tries. Blood-letting, opium, calomel, and external 
warmth, have every where been first resorted to, in 
attempting to subdue the disease. 

Drs. Russell and Barry, agents of the British Gov- 
ernment, and who witnessed the disease in Russia, thus 
allude to the treatment. 

6 Of the two great classes of functions performed by 
the organs of which man is composed, one only is at- 
tacked in this disease. The operations of the senses 
and of the intelligence are either left untouched, or are 
affected but in a secondary manner. 

Those functions, on the contrary, by which existence 
as a living being is preserved, — those complicated 
powers, by means of which we are forever appropria- 
ting and converting into a part of ourselves, portions 
of the matter around us, — are all and at once deran- 
ged by the attack of this terrible malady. Nutrition 
is annihilated ; respiration becomes difficult, irregular 
and inefficient ; the involuntary muscles no longer per- 
form their task ; the voluntary are drawn into con- 
tractions by other powers than the will ; the blood 
ceases to circulate ; its physical properties are alter- 



THE CHOLERA, 167 

ed; its serous portion is suddenly thrown out upon 
the intestinal mucous surface of the body ; the secre- 
tions are all arrested ; and animal heat is no longer 
produced. 

Under such rapidly destructive, and almost univer- 
sal derangement of functions, the most energetic efforts 
should be directed to re-produce what the disease has 
rendered nature unable to keep up, viz., 

1st. Fluidity, heat, and motion in the blood. 

2ndly. Regulated action in the voluntary and invol- 
untary muscles. 

Lastly, but above every other consideration, renewed 
energy in the nervous centre, the source of all vitality 
and function. 

No remedy at all approaching to the nature of a spe- 
cific has been as yet discovered for this disease. In 
fact, no one mode of cure can be usefully employed un- 
der all the circumstances of any disease. The grades 
of intensity, and the grouping of the symptoms with 
which spasmodic cholera makes its attacks, vary with 
the conditions of the subject ; its treatment, therefore, 
must vary with these grades and conditions. 

The leading preliminary symptoms generally are, 
either diarrhea, spasms, apoplectic vertigo, with nau- 
sea, imperfect vomiting, or various combinations of 
these symptoms. 

When the diarrhea affords time for distinct treat- 
ment, it ought to be arrested at once by the most 
prompt and efficient measures ; by opium in moderate 
doses ; astringents ? local bleeding by leeches, if the 
subject be; plethoric ; by cordials and sulphate of qui- 
nine, if there be cold sweats ; by confining the patient 
strictly to bed, and keeping up heat ; by diet ; by 
emetics. 



168 TREATMENT OF 

Should spasms be the first and leading symptom, 
subnitrate of bismuth, cupping along the course of the 
spine, cordial and antispasmodic medicines, opium, 
frictions, and dry warmth are indicated. 

But when the patient is suddenly seized with ver- 
tigo, nausea, coldnesss, loss of pulse, blueness of the 
skin, shrinking of the features and extremities, with 
more or less watery discharges and cramps ; constitu- 
ting an aggravated case of the worst type ; whether 
this state shall have come on without warning, or shall 
have supervened upon either or both of the preliminary 
sets of symptoms already mentioned, time must not be 
wasted upon inert measures. Such a patient w r ill inev- 
itably perish, and within a few hours, if the paralysed 
vital functions be not quickly restored. 

Let him then be immediately placed between warm 
blankets ; and should no medical person be at hand, 
let two table-spoons full of common kitchen salt, dis- 
solved in six ounces of warm water, be given immedi- 
ately, and at once if he be an adult. Let dry and 
steady heat be applied along the course of the spine, 
and to the pit of the stomach (if no other means be at 
hand) by a succession of heated plates or platters. 
Let the upper and lower extremities be surrounded 
with bags of heated bran, corn, ashes, or sand, and as- 
siduously rubbed with a warm hand, and a little oil or 
grease to protect the skin. Energetic, complete vom- 
iting will probably be produced by the salt ; and per- 
haps bilious purging, with tenesmus. 

Should a medical man be on the spot, a moderate 
bleeding, if it can be obtained, would be desirable, 
previously to, or immediately after the administration 
of the salt, or of any other emetic which may be pre- 
ferred. 



THE CHOLERA. 169 

The extensively deranged action of those organs 
whose nerves are chiefly derived from, or connected 
with the spinal marrow, the anatomical characters 
found about that great source of vitality after death, 
in many cases of the disease, together w 7 ith the success 
stated by Dr. Lang, chief physician at Cronstadt, to 
have attended the practice mentioned below, founded 
upon these views, in 12 out of 14 aggravated cases, 
fully justify the following recommendation. 

In cases such as those just described, let the actual 
cautery be freely applied to one, two, or more places on 
either side of the spine, as if for the purpose of form- 
ing good sized issues. Should the heated iron have 
produced any excitement of the nervous power, and 
the salt emetic have caused any portion of the bile to 
flow through its proper duct, a great step will have 
been accomplished towards recovery from the stage 
of collapse. Cordials and opiates judiciously adminis- 
tered; sinapisms and other external stimulants; mer- 
curials with mild aromatic aperients, which the intelli- 
gence and activity of British medical practitioners will 
not fail to adapt to the actual circumstances of each 
case, will conduct the patient safely to the stage of re- 
action. 

The organs, during the collapse of this disease, prob- 
ably owing to deficient vitality, often give no indica- 
tion of having been acted upon by repeated doses of 
certain powerful medicines, which under other cir- 
cumstances would have produced the most decided 
effects. It is therefore suggested that this temporary 
insensibility of the system should nat inculcate the ad- 
ministration of such quantities as could, by accumula- 
tion, when the organs begin to recover their vitality, 
give rise to unfavorable results. 



170 TREATMENT OF 

Thirst being a most distressing symptom in this dis- 
ease, the quality and temperature of the drink should 
perhaps be left to the choice of the patient ; but the 
quantity taken at a time should not exceed four oun- 
ces, and should be acidulated with nitrous acid, if the 
patient will bear it. 

Should the disease prove extensively and rapidly 
epidemic in a large community, it would be prudent 
to establish stations at convenient distances from each 
other, where medical assistance and medicines might 
be procured without the risk of disappointment or de- 
lay. The details of these arrangements are left to 
the wisdom of local boards of health. 

As to the symptoms of the consecutive stage of fe- 
verish re-action in cholera, they differ but little, if at 
all, from those of ordinary typhus, except, perhaps, 
in the greater rapidity with which they but too often 
run to a fatal termination ; and as this kind of fever 
is treated in no part of the world with more success 
than in England, the entire management of this stage 
of the disease is left to the zeal and science of the pro- 
fession at large. 

Attentive nursing, and assiduous, well-directed 
rubbing, are of the utmost importance ; a strictly hor- 
izontal position, however, must be maintained until 
the heart shall have partly, at least, recovered its ac- 
tion. An erect, or even semi-erect position, during 
the collapse, has been often observed to produce in- 
stant death. Warm baths, therefore, for this and 
other reasons, are worse than useless; evaporating 
fluids, and indeed all moisture applied to the skin, 
seem to be contra-indicated for obvious reasons. Hot 
air baths, so contrived as to be applicable in a re- 



THE CHOLERA. 171 

cimibent posture, and admitting access to the patient 
for the purpose of friction, may be of use. 4 " 

When the cholera first appeared in Russia, the 
French Government also sent an agent to St. Peters- 
burg to investigate the nature of the disease. 

This agent had abundant opportunity to witness 
and treat the disease in a large hospital of 250 pati- 
ents at St. Petersburg, and the following are his 
remarks respecting the treatment of Asiatic cholera 
at that place in 1831. 

" There is no disease in which the same treatment 
will apply to all possible cases ; on the contrary, we 
must always take into consideration the constitution 
of the patient and the stage of the disease; and just 
so it is with respect to the treatment of cholera. Let 
it not be thought, that, in this malady, it is sufficient, 
as it is in many others, to administer remedies inter- 
nally : on the contrary, these remedies have produced 
comparatively but little effect ; whilst assiduous care, 
combined with exterior applications faithfully perse- 
vered in, have succeeded in restoring patients labor- 
ing under very severe attacks. 

The treatment which 1 have followed, as well as 
many of my colleagues, and from which we have 
obtained the greatest success in the first stage or de- 
gree of the malady, and which has produced four 
times upon myself the most salutary effect during the 
course of the epidemic, was the following : As soon as 
the first symptoms indicated appear, that is, loss of 
appetite, flatulent noise in the lower part of the ab- 
domen, even vertigo and anguish, accompanied by 
nausea and diarrhea, we must go to bed, and take 



172 TREATMENT OF 

immediately a eup of strong coffee, without milk, 
with or without sugar ; and, soon after, from four to 
six drops of oil of peppermint upon a piece of sugar : 
we must apply, at the same time, a bag filled with 
oats, ashes or bran, very warm, upon the abdomen, 
changing it as often as possible, and keeping our- 
selves quite warmly covered. We may repeat the 
same means, until we have succeeded in bringing on 
a very copious perspiration, which, when it can be 
produced, brings at once the attack to a favorable 
crisis. If, however, much headach, and a severe 
pain in the pit of the stomach should be experienced/ 
and should not yield to a large mustard plaster ap- 
plied to it, bleeding, to the amount of a pint, or even 
a pint and a half, becomes indispensable, and must 
even precede all other remedies, if the constitution of 
the patient be strong and sanguine ; even the most 
debilitated ought not to apprehend any ill conse- 
quences from bleeding if the symptoms above detail- 
ed are strongly marked, for their debility is deceitful, 
and will cease as soon as they are delivered from the 
blood which was stagnant, or had not a sufficiently 
free circulation. 

It is still more important to send the patient to bed, 
if he has the diarrhea, for many people have experi- 
enced the full development of cholera, and even have 
died, for having, in the beginning, refused to take 
their bed for a simple diarrhea. I have often cured 
by mere repose, and the warmth of the bed, a diar- 
rhea which would have certainly degenerated into 
cholera. I did not even permit my patients to rise 
from their beds for the purpose of evacuation, but they 
made use of bed pans. 

For diet, chicken broth, with a little rice or sago 



THE CHOLERA. 173 

boiled 4 or 5 hours, to which we may add a little red 
wine. A decoction of salep, in the juice of the 
black muscade grape, is likewise to be recommend- 
ed. The drink must consist of rice water, or toast- 
water, with a little red wine. 

If the oil. of peppermint, the tea of melissa, the 
ipecacuanha administered every three hours in small 
doses of one-tenth of a grain, and the warm bags, do 
not stop the diarrhea, it becomes necessary to apply 
mustard plasters upon the whole surface of the ab- 
domen ; and, if we should not thus succeed in over- 
coming the disposition to vomit, we may give soda 
powders composed of acidulated carbonate of soda, 
10 grains ; essential salt of tartar, 6 or 8 grains, and 
of elio-sachar-citri, 10 grains; swallowing immedi- 
ately after a tea-spoonful of lemon -juice, with a little 
water. In such cases, I have often arrested the pro- 
gress of cholera by means of emetics and castor oil, 
the only purgative 1 have used during the epidemic. 
I have not been less fortunate in cases of diarrhea. 

In the second stage, in which medical aid is cer- 
tainly very important, nothing however ought to be 
done with precipitation. We must never forget that 
the first thing to be attended to, is to restore the blood 
to its circulation and organical warmth. In the 
greater number of cases, w T e begin the treatment, by 
applying to the whole surface of the abdomen a large 
mustard plaster, which must cover the pit of the 
stomach. If, however, the patient is too irritable, the 
mustard plaster may be divided, and a number of 
small plasters applied in different places, one after 
another, though, to speak the truth, this last method is 
not so active and effectual as the former. Frictions 

must be instituted over the whole body of the patient, 

15* 



174 TREATMENT OF 

and that is best done by four persons rubbing all at 
once, with dry flannel, powdered over with mustard. 
1 have always observed, that frictions made with spi- 
rituous liquors, were much less effectual, inasmuch as 
the body grew cold as soon as they ceased rubbing it. 
The same has been observed by many of my col- 
leagues. For the parts of the body in which the 
cramps became too severe, I made use of a mixture 
of oil of turpentine, three ounces ; with oil of tusqui- 
am, a half an ounce \ oil of gilliflower, three ounces 
and a half; spirits of sal ammoniac, from half an 
ounce to six drachms — oil preserving the heat of the 
body much better than spirituous liquors. 

This treatment is followed by mustard plasters on 
the calf of the legs, the thighs, the soles of the feet, 
the arms, the spine, either alternately, or even all at 
once, according to the urgency of the case. 

We have been taught by experience, that baths of 
all kinds, including vapor baths with vinegar and 
water, not only remained without effect, but even 
give great pain to the patient, who is exposed to take 
cold. If bathing was so effectual at Moscow, we 
must attribute it to the season ; for the plague broke 
out in that capital in the month of October, and lasted 
the whole winter ; in consequence of which, the pa- 
tients were carried to the hospitals half frozen. 

It has been equally impossible for us to follow the 
internal treatment prescribed either by the English 
physicians, or by those of Moscow ; that is, we could 
use opium only with the greatest circumspection, for 
that active remedy has unfortunately produced, too 
often, congestions of the brain so intense that nothing 
could calm them ; and that, too, without arresting the 
progress of the malady. 1 can say the same of calo- 



THE CHOLERA. 175 

mel administered in large doses : the use of the latter 
has been almost entirely rejected. 

1 have been more fortunate in the use of bismuth 
powders, recommended by Dr. Leo of Warsaw, and 
taken every two hours in doses of three or four grains, 
with ten grains of sugar, though this remedy has not 
always answered my expectations. Much more fa- 
vorable results were obtained from a remedy truly 
Russian, and which has been lately recommended by 
Dr. Searle of England, who practiced at Warsaw 
during the epidemic. This remedy has been, for ve- 
ry many years, used by the Russians in affections 
analogous to cholera, but much less intense; it con- 
sists in a solution of common salt, two table-spoons- 
ful of which must be dissolved in a glass of boiling 
water, strained, and taken in one draught, while yet 
ukewarm; it is thrown up in a very few minutes, 
md in the greater number of cases, it is already mix- 
ed with a little bile ; which circumstance is a favora- 
ble one, since it proves that the spasm of the biliary 
ducts has diminished. One table-spoonful of the 
same solution is afterwards given every hour ; this 
dose is taken cold ; and is followed by a smaller dose 
still ; that is, by a tea-spoonful, taken at a time, until 
all alarming symptoms have subsided. It has also 
frequently happened, and that even in very severe at- 
tacks, that the first dose was sufficient. At other 
times, namely, when there was no bile mixed with 
the water thrown up, I have been obliged to make a 
venesection for the purpose of taking six or eight 
ounces of blood ; and, when the blood would not run, 
I applied leeches to the pit of the stomach, or drew 
blood from it by cupping, and the relieved the pa- 



176 TREATMENT OF 

tients of a burning sensation, and of the fatigue of fre- 
quent vomiting. 

The patients treated in this manner, that is, with 
a solution of common salt, were often very soon re- 
stored to health, and could hardly be recognized af- 
ter a few hours. In a few cases, the disease took the 
character of a congestive typhus, but not very intense. 
In a very few cases, I have been obliged to discontin- 
ue the solution of common salt to give the bismuth in 
the above indicated doses, or camphor dissolved in 
ether, or mixed with the tincture of canclla, or any 
kind of aromatic water, to which should be added, a 
mucilage of gum-arabic and sugar. Such are the 
remedies which have best succeeded. As soon as 
the cholera assumed the character of a typhus fever, 1 
applied leeches behind-theears or on the neck and cold 
water and even ice on the head, blisters on the neck and 
calf of the legs; prescribed castor oil when it became 
necessary, and chiefly oxygenated muriatic acid, ta- 
ken in doses of half an ounce, or even an ounce, upon 
six ounces of decoction of salep or marsh-mallow. 

With respect to drink, 1 consulted the patient's own 
wishes, not, however, before he had thrown up the 
solution of salt. The best drink, however, was cold 
water often repeated, but in small quantities : I ob- 
served that the patients always ejected w r arm drinks. 
I have even given ice broken in small pieces, and 
recommending that only a part of it should be swal- 
lowed, and the other suffered to melt in the mouth. 

In the third stage, which is that of paralysis, there 
is hardly any remedy. Emetics, phosphorated ether, 
that is, two grains of phosphorus and two drachms of 
ether, well shaken together, on what is still better, a 
solution of six grains of phosphorus in a half ounce of 



THE CHOLERA. I77 

oil of sweet almonds, and taken every half an hour in 
doses often drops, upon the same quantity of ether 
as recommended by the physicians of Moscow. The 
whole class of excitants, such as the spirits of harts- 
horn, camphor, musk, Champaign wine, sulphate of 
quinine, &c., administered in the supposition of an 
intermittent fever ; frictions, mustard plasters, baths, 
pumping of cold water upon the pit of the stomach 
and spine : commonly produced no other effect than 
to prolong, sometimes, the sufferings of the patient 
If, however, we should observe some favorable symp- 
toms, it becomes essential to avoid a too active inter- 
nal treatment. 

The faculty does not recognize any predominant 
remedy, nor any one very remarkable for success in 
particular cases ; a circumstance which may be at- 
tributed to the rapidity of the progress, and the malig- 
nant character of the epidemic. It is probable that 
cholera, like all other epidemic diseases, such as small 
pox, scarlet fever, &c.,is, perhaps, of different char- 
acters, more or less malignant. That may also ac- 
count for certain remedies, such as bismuth, having 
proved sometimes so effectual. 

Additional reflections upon the use of bleeding, and of 
opium, in the treatment of cholera. 
I have adopted bleeding only with the young and 
plethoric patients, and that at the very beginning of 
the attack, in case of severe pain, or when the above 
indicated remedies for the first stage have not had the 
desired effect ; it is then that bleeding was so effect- 
ual, that no other remedy could be substituted for it, 
The object of bleeding is to diminish that part of the 
blood, which through the influence of miasm, isdis- 



}78 TREATMENT OF 

posed to stagnate in the interior part of the body. By 
means of bleeding, we prevent, or at least, diminish 
the spasm, as well as the venous congestion which 
results from it ; and by that means relieve the heart 
and lungs from all oppression, in order to restore to 
them the full power of their respective functions. 
We can obtain that result only in the first two stages 
of the malady ; that is, before circulation has ceased 
in the articulations of the hands. In cases requiring 
bleeding, it is, consequently, of the greatest impor- 
tance to bleed as soon as possible, for the blood sensi- 
bly alters in its chemical nature, and no longer runs 
from the vein, or, if it does, it is with with great diffi- 
culty, and in so small a quantity as renders it inade- 
quate to the relief of the patient. When the disease 
has too far advanced, bleeding has sometimes hasten- 
ed death. 

The nature of the epidemic at St. Petersburg con- 
vinced me of the impossibility of following the method 
of the English physicians, who, in India, bleed to the 
amount of more, and much more, than a pound of 
blood. 1 have always confined myself to ten, eight, 
or six ounces. 

The use of opium, so much extolled by English 
physicians in India, and by them prescribed in large 
doses, has as little succeeded in my practice as in 
that of my colleagues. It has, on the contrary, ac- 
cording to all our observations, served only, as said 
before, to determine the blood towards the brain, and 
to render the state of stupor and somnolence much 
more difficult to overcome, than when w 7 e made no 
use of that remedy; hence 1 soon gave it up almost 
entirely. What has led me to the adoption of that 
plan, is, that vomiting and diarrhea are only symp- 



THE CHOLERA. 179 

toms, which, in the more severe attacks, are not the 
most prominent; it even very frequently happens, that 
these symptoms are hardly perceptible : and, as we 
cannot admit that the individual attacked with chol- 
era, dies solely of starvation caused by vomiting and 
diarrhea, but in consequence of the paralysis of the 
nervous system, chiefly that of the lower part of the 
abdomen, or ganglionic system, and of the chemical 
and orgariical decomposition of the blood, we may 
easily conclude that opium cannot be a universal 
remedy for cholera. 

The brilliant success mentioned by English physi- 
cians has been of very rare occurrence, and due only 
to the very large doses which they have had the cour- 
age, or rather the temerity to administer. The ordi- 
nary doses, as we have had occasion to observe in 
our experiments at St. Petersburg, have been very 
generally injurious ; for they are not active enough 
in the beginning, and paralyze, in their secondary 
effect, very visibly and strongly, all the functions of the 
patient : they contribute very much to the complete 
development of somnolence, which is sometimes con- 
sequent to cholera ; but then it is less strong, and can 
be soon removed, if no opium has been adminis- 
tered." 

Dr. Lefevre, physician to the British embassy at 
St. Petersburg, and who had ample opportunities of 
seeing the disease, and ascertaining the best method 
of treatment, remarks, " The epidemic cholera, upon 
its first invasion, baffles all attempts to conquer it ; 
but it gradually loses its intensity, and towards its de- 
cline, becomes as tractable as other disorders of the 
alimentary canal." 



180 TREATMENT OF 

Dr. L. witnessed the employment and the general 
failure in the first of the epidemic, of the following 
methods of treatment, all of which proved serviceable 
at a more advanced period of the disease : — venesec- 
tion, sweating by various processes, calomel and opi- 
um, rhubarb and magnesia, sub-nitrate of bismuth, 
hot baths, frictions with hot cloths, &c. &c. 

Dr. L. is, however, an advocate for bleeding, and 
thinks it decidedly beneficial, when employed judi- 
ciously. He remarks, 

" Bleeding from the arm in the first stage, when 
the pulse is full and the temperature not reduced, is 
often sufficient to cut short the disease. The quanti- 
ty of blood to be drawn should be but small ; eight 
ounces will be sufficient to allow the remainder to 
circulate more freely and relieve the heart, and this 
will not too much exhaust the patient. 

The blood is generally thicker than usual, highly 
carbonized, and forms a loose coagulum. I do not 
know if the blood of cholera patients has been analy- 
zed during the present epidemic. The patient usually 
feels immediate relief, particularly where the head 
has been much affected. He should be bled in the 
horizontal posture, and remain quiet for some time 
afterwards. The operation of medicines is generally 
much facilitated by a small bleeding. 

The absence of the pulse is no prohibition to the 
use of the lancet, unless this is accompanied by other 
symptoms of great debility, and the system has been 
exhausted by previous evacuations, and the surface 
is covered with a cold clammy sweat ; in such instan- 
ces 1 have never seen blood-letting serviceable, 
though many assert the contrary. In some cases, the 
pulse ceases to beat very early, but upon opening a 



THE CHOLERA. 181 

vein the blood flows slowly at first, gradually the cur- 
rent becomes fuller and stronger, the pulse beats very 
sensibly, and the heart thus relieved is enabled to 
continue the circulation." 

The following was Dr. Lefevre's own mode of 
practice, when called in at an early period of the dis- 
ease: 

" If the patient is robust, the pulse still perceptible, 
and the system not too much reduced by evacuations, 
I order from six to eight ounces of blood to be drawn 
from the arm, the patient being first put to bed in the 
recumbent posture. 

The following draught is then to be given : 

Laudanum and asther, of each twenty-five drops. 
Strong peppermint water, an ounce and a half. 

If this be rejected, it should be repeated immedi- 
ately ; if the second be likewise not retained, then a 
clyster of linseed tea with fifty drops of laudanum 
should be administered. 

It often happens that the patient after taking the 
first dose, falls asleep, and wakes in perfect health 

A large sinapism to the abdomen, and bottles of 
hot water to the feet, should not be omitted ; if these 
means produce speedy relief, an ounce of castor oil 
should be prescribed as soon as the stomach and bow- 
els are quiet." 



TREATMENT OF THE CHOLERA IN ENGLAND. 

It has been already stated, that the cholera ap- 
peared at Sunderland, in the north of England, in 

the autumn of 1831. 

16 



182 TREATMENT OF 

Previous to that time, it was predicted by medical 
men, that if the disease should appear in England, it 
would exhibit a less violent character than it had in 
India. 

This prediction has hitherto proved correct. In no 
country has the cholera been more mild than in the 
large towns of England. In London, u the largest 
city ever visited by pestilence," the disease prevailed 
but for a short time, and destroyed a less number than 
in almost every other city it has visited. 

This exemption of modern Babylon, with its im- 
mense mass of needy, filthy, starving and vicious 
population, is one of the most mysterious circum- 
stances that has hitherto occurred in the progress of 
the cholera. 

There is, however, reason to fear, that London, 
Manchester, and many other of the large towns of 
England have been spared only for a season ; like 
several towns in Asia which were not visited for a 
year or two while the disease prevailed around them ; 
but were afterwards ravaged by this modern plague 
in its most violent form. 

The treatment of the cholera in England has not 
varied much from that which had been adopted in 
India and other countries. Bleeding, emetics, calo- 
mel, opium and external heat, have been among the 
chief remedies employed. 

The disease, however, was not so new to the medi- 
cal men in England, when it first appeared there, as 
it was to the physicians in the north of Europe when 
the disease first invaded Russia. 

Many English Physicians had witnessed much of 
the disease in India, and had given full and accurate 
accounts of it, to the British public. Among other 



THE CHOLERA. 183 

British physicians, now resident in England, and who 
had seen the disease in India, and given accurate 
descriptions of it, as it appeared in that country, is 
the celebrated James Johnson, Physician Extraor- 
dinary to the King of England, and editor of the far 
famed Medico Chirurgical Review, &c. &c. 

In November last, Dr. Johnson submitted to the 
Westminster Medical Society, a series of proposi- 
tions respecting the cholera ; and although but part 
of them relate to the treatment of the disease, yet 
they are all so correct and important ; embodying in 
a small space most that we know concerning this dis- 
ease, that I am induced to extract the whole of them, 
and place them in this part of the volume. 

Propositions. 

" i. That in epidemic cholera, as in most other ep- 
idemics, a poison or sedative principle, whether ema- 
nating from the earth, from animal or vegetable bod- 
ies on the earth, or engendered in the air, strikes a 
predisposed individual, and, after an uncertain period 
of incubation, produces a train of phenomena, form- 
ing the subject of subsequent propositions. In spora- 
dic cholera, the general or diffusive cause is absent ; 
but when the common exciting causes are strong, 
and the subject highly predisposed, severe, or fatal ca- 
ses will occur, where the symptoms cannot be distin- 
guished from those of the epidemic cholera. 

2. The effects of the choleric poison exhibit a 
great analogy to those produced by the virulent conta- 
gion of typhus, and the concentrated miasmal exha- 
lations that give rise to malignant fevers, remittent 



184 TREATMENT OF 

and intermittent; such as have been seen in Batavia 
and other highly malarious places. 

3. This poison shows its effects according to the 
evidence of our senses, first, on the nervous system, 
as evinced by the prostration of strength, — by the af- 
fection of the head, — by the arrest of the secretions 
(dependent on nervous energy), and, in fact, by a 
depression of the whole of the sensorial functions, as 
well as those of the organic life. 

4. The secondary effects of the choleric poison are 
shown in the vascular system. The heart acts fee- 
bly, — the circulation recedes from the surface, and 
the blood accumulates in the vessels of the internal or- 
gans ; decarbonization and calorification cease, or 
are greatly diminished ; the temperature of the body 
falls to that of surrounding inanimate substances ; 
paleness is changed to blueness ; and the influence 
of the ganglionic system of nerves seems to be near- 
ly suspended, if not annihilated. 

5. It is at this period that nature appears to make 
violent, but too often unsuccessful efforts, to restore 
the broken balance of the circulation, and to re-es- 
tablish the secretions, by sickness and purging ; the 
ejected fluids being exudations, rather than secre- 
tions. 

6. If nature does not succeed by the above men- 
tioned efforts to restore circulation, secretion, and 
consequently oxygenation and calorification, these 
efforts themselves prove auxiliaries to the choleric 
poison in destroying life. 

7. We are not, in our present state of knowledge, 
certain whether the spasms be merely the effects of 
the poison on the nervous system, or an effort of na- 



THE CHOLERA. 185 

ture to resist it ; but they, like the sickness and pur- 
ging, tend ultimately to exhaust the powers of life. 

8. If nature, (by which I mean the constitution), 
whether with or without aid, be able to resist the first 
or depressive shock of the poison, and institute a re- 
action in the system, that re-action, in a great majori- 
ty of cases, becomes a fever, exhibiting a new train of 
phenomena, and demanding a different mode of treat- 
ment. If this view be correct, it would lead to the 
inference that the choleric symptoms constitute the 
first or cold stage of a choleric fever. 

9. If reaction, with restoration of circulation, secre- 
tion, and oxygenation, do not take place, the patient 
dies in a state of asphyxia, the intellectual powers oft- 
en remaining but little impaired, till the last glimmer 
of the lamp of life is extinguished. This has been 
often witnessed in concentrated miasmal fevers, both 
within and without the tropics. 

10. Pathology. — All the changes which present 
themselves in the dead body, are, in my opinion, ef- 
fects^ not causes, of the disease ; with the exception 

of the congestion of black blood in the internal or- 
gans, which is almost the only phenomenon observa- 
ble when cholera terminates fatally in a few hours. 
The traces of inflammation in various organs after 
death, indicate the causes or effects of the re-active fe- 
ver, rather than of the cholera which precedes that 
fever. 

11. Treatment. — As we have no means of expel- 
ling or neutralizing the poison, we can only endeavor 
to counteract its effects, and to assist nature in her re- 
medial movements. 

12. The primary or essential indication is to restore 

the equilibrium of the circulation. That equilibrium 
16* 



186 TREATMENT OF 

effected, a restoration of secretion, calorification, and 
oxygenation follows. 

13. The balance of the circulation is to be restored 
partly by internal, partly by external means; but al- 
ways by several means simultaneously employed, at 
the very earliest period of the disease. 

14. Venesection may appear a desperate remedy, 
but we have a desperate disease to combat. I propo- 
sed this measure many years before the epidemic 
broke out, and it has been adopted to a very considera- 
ble extent, both in Asia and Europe. I proposed, and 
would still propose venesection, with a two-fold view ; 
first, to relieve the heart and internal organs from a 
portion of that deluge of black blood in which they 
may be said to be drowning ; — secondly, to turn, as 
it were, the tide of the circulation from the centre to 
the surface of the body. This measure I would chief- 
ly confine to the young, the robust, and the previous- 
ly healthy, and in them contemporaneously with, or 
subsequently to, the measure which forms my next 
proposition. 

1 5. The first internal remedy which I propose, both 
in aid and in imitation of nature, is a stimulant emet- 
ic, as infusion of mustard seed, or what perhaps would 
be better, the sulphate of zinc. I propose this 
from a conviction founded on observation, that of all 
the means which nature or art can bring into opera- 
tion, the act of 'Jull vomiting is the most powerful in 
driving the blood from the trunks to the capillaries— 
from the internal organs lo the periphery of the body. 
It is also the most universal excitant of secretion 
in every glandular structure of the living machine. 
Nausea and retching are quite different in their effects 
from the operation of full vomiting. Nausea and 



THE CHOLERA. 187 

retching depress the power of the heart and nervous 
system, and prevent the blood from flowing to the sur- 
face ; full vomiting impels the circulation with such 
force into the superficial vessels, that it is extremely 
difficult to stop the flow of blood from the orifice of a 
vein during vomiting. I have seen the blood come 
from a vein under such circumstances;, with all the 
characters, or at least the appearance of arterial 
blood. This proposition is well exemplified by sea- 
sickness^ of which I have had painful personal expe- 
rience. An unfortunate landsman bears a close re- 
semblance, during the first storm at sea, to a man 
with cholera. He staggers about the deck, or clings 
to the railings of the lee-gangway, striving to keep 
down the rebellious heavings of his own stomach. 
But all wont do 5 up it comes ; and during the first 
vomitings, I have seen the blood gush from the mouth, 
nose, and even the eyes of the sea-sick sufferer. From 
being actually blue with nausea, his face becomes 
red with vomiting. But the cause of the sickness 
still continuing, he ultimately becomes pale and ex- 
hausted ; he is like a man who takes a fresh dose of 
tartar emetic, after each paroxysm of vomiting. The 
wonder is that he does not die ; some have died. It 
is curious that Coelius Aurelianus, who gives the best 
ancient account of cholera morbus, places sea-voya- 
ging among the causes of that disease. 

It is but justice to state that Mr. Boyle proposed 
and practiced full vomiting in the epidemic cholera 
ten years ago 5 and I have the Very best authority for 
affirming that this practice, when it was pursued on 
the Continent, was eminently beneficial. 

16. As soon as vomiting has produced its salutary ef- 
fect on the circulation, or has failed to produce that ef- 



188 TREATMENT OF 

feet after a fair trial, I would propose diffusible stimuli, 
with calomel and opiates, but not in immoderate do- 
ses. Brandy and laudanum , as the most readily pro- 
cured, and the least likely to be loathed, are perhaps 
the best. But the choice of stimulants must be left to 
the practitioner ; and the danger of inducing subse- 
quent inflammation should be carefully borne in mind. 
Calomel alone would probably be the best medicine 
after the emetic. 

17. The remedies above mentioned, in moderate, 
but efficient doses, seem to impart vigor to the heart 
and nervous system, through the medium of the stom- 
ach, while they mitigate the spasms, and restrain the 
useless or injurious exudations of fluids from the in- 
testinal canal, the mercury changing that exudation 
into secretion. 

N. B. Would not the inhalation of oxygen gas be 
beneficial ? 

18. The external remedies are three — heat, fric- 
tion, and counter-irritation. These three means 
should be employed, not only simultaneously with re- 
spect to each other, but contemporaneously with the 
internal remedies. They should be also so employ- 
ed, that the patient may not be required to throw a 
single voluntary muscle into action. Every muscu- 
lar movement, even in that of sitting up in bed, is pre- 
judicial, or absolutely dangerous, during the exhaust- 
ing orgasm of cholera. An apparatus permitting the 
application of heat, friction, and counter-irritation, 
without the necessity for any muscular exertion on 
the part of the patient, will be shown to the So- 
ciety. 

Query. — As the cramps and spasms are chiefly 
confined to the extremities, and as the exhausting 



THE CHOLERA. 1§9 

pain of these cramps is in proportion to the contrac- 
tion and swelling of the affected muscles, would not 
firm compression by a bandage, mitigate the spasms ? 
Patients in cholera often cry out for the most violent 
extension and pressure of the craiftped muscles. 

1 9. Prophylaxis. — Conceiving myself, as well as 
every member of this Society, bound to abstain from 
all discussion of the question of contagion, 1 shall 
condense the subject of prevention into four words, — 
temperance, cleanliness, ventillation, and fearless- 
ness : — in fine, the pursuance of all those means 
which tend to preserve general health, and the avoid- 
ing of all those causes which predispose to common, 
or indigenous diseases of our own climate.' 

In respect to the cause of the epidemic, we have 
no reason to alter the conclusions to which we have 
come on former occasions — namely, that the disease 
originates in causes of which we are ignorant, and 
over which we have no control, and that, in crowded, 
filthy, and ill-ventillated places, it takes on an infec- 
tious character, tending still farther to propagate and 
heighten the danger of the disease. This is the doc- 
trine which w 7 e have always maintained, from an un- 
biassed consideration of facts. We shall be ready to 
alter our opinion, whenever our experience and re- 
flection shall convince us that we are wrong. The 
disease has now come within the range of observa- 
tion ; and English practitioners will not have to 
ground their conclusions on reports from the banks of 
the Ganges, the Ural, the Wolga, the Euphrates, or 
the Nile, only— they will probably have ocular dem- 
onstration — and to that ordeal we cheerfully sub- 
mit." 

When the cholera appeared at Sunderland, New- 



190 TREATMENT OF 

castle, and the neighboring towns in the north of Eng- 
land, medical men from all parts of the country, with 
a noble and generous devotion to the cause of suffer- 
ing humanity ; hastened to the places where this pesti- 
lence prevailed, and observed for themselves the 
progress and the nature of the malady, and endeavor- 
ed to ascertain the means most likely to mitigate its 
severity. 

They did not wait to learn if the disease was conta- 
gious or not, or to calculate the amount of the risk they 
run, in thus visiting infected districts, and personally 
examining the sick, the dying, and the dead. But 
with a most praise-worthy spirit, which has been man- 
ifested by the profession in all countries where the 
•cholera has appeared, they determined to inform 
themselves as soon as possible, by personal observa- 
tion of the nature of the disease, and thus qualify 
themselves to afford all the relief in their power to 
their fellow men. 

Several of the distinguished physiciansin England, 
who thus left their homes and witnessed the disease 
at Sunderland, Newcastle, and other places, have 
published the results of their observations, and from 
their publications I shall make large extracts. 

Dr. Thackrah, of Leeds, previously known to the 
medical profession by other publications, had ample 
opportunities of witnessing the cholera at Newcastle 
and Gateshead, and has given to the public the re- 
sults of his experience at those places. Dr. T. 
describes an epidemic cholera which appeared in 
Leeds, in 1825, and which exhibited the same symp- 
toms as the present epidemic. But 1 shall refer to 
the epidemic of 1 825, in another part of this volume. 
Dr. T. is a decided advocate for venesection, and for 



THE CHOLERA. 191 

scruple doses of calomel. He saw this practice prove 
decidedly beneficial in Sunderland, during the present 
epidemic. 

George Hamilton Bell, author of an excellent 
treatise on the Cholera Asphyxia, and who had seen 
the disease in other countries, was deputed by the 
Edinburgh Board of Health to visit the places in the 
north of England where it prevailed. He also bears 
testimony to the beneficial effects of blood-letting, and 
relates a case where it proved decidedly beneficial, in 
a well marked case of cholera asphyxia, and w 7 hen 
it was resorted to in the stage of collapse. 

Dr. Ogden of Sunderland, in a letter to the Editor 
of the Medical Gazette, thus refers to the treatment 
of the disease in that place : 

" On the important subject of cure, I fear there is 
little satisfactory to be said. The number of recove- 
ries from cold blue cholera has borne a very small pro- 
portion to the deaths. Of the 330 recoveries reported, 
a great majority was not attended with coldness and 
lividity of the extremities, great collapse, and loss of 
pulse, so characteristic of the dangerous cases. 

The Indian rule of bleeding has been freely tried 
with various success ; sometimes blood could be ob- 
tained, at others it could not ; in the latter case, no 
harm was done by the attempt. When blood was 
obtained in the commencement, it was often product- 
ive of benefit ; the circulation becoming equalized, 
the patient expressing great relief, the pulse improving 
and continuing perceptible to the termination, wheth- 
er in death or recovery. Sometimes, again, it ap- 
peared to diminish the powers of life. On the whole? 



192 TREATMENT OF 

it is a doubtful remedy ; a criterion is wanting to 
guide us in the employment of it. Dry external heat 
is of great importance ; hot air baths have been tried, 
but the deadly coldness of the extremities is totally 
unaffected by them ; the contact of hot solids, as 
bricks, bottles, bags of sand, is much better. Fric- 
tion of the extremities with hot flannel should be next 
to incessant ; it is one of the few means we possess of 
restoring the circulation ; indeed, there have been re- 
coveries principally due to the assiduity with which 
it w 7 as employed. Brandy is always used, often re- 
jected a few minutes after it is swallowed. Opium 
sometimes relieves the sickness, sometimes it does 
not. Calomel, in the majority of cases, appears to 
possess little or no efficacy. Viewing the mucous 
membrane and the skin as one continuous surface, 
and considering the suspension of their powers of ab- 
sorption, we are led to the employment of such reme- 
dies externally and internally, as act as mere stimu- 
lating applications. Sinapisms are to be applied to 
the epigastrium, to allay the vomiting, and to the 
calves and thighs to cure the spasm. A mustard 
emetic has often succeeded in restoring the pulse. 
Oil of turpentine by mouth in 3ss. doses, and by in- 
jection, is a powerful stimulant. Camphor and the 
essential oils of mint and cajeput are inferior to oil of 
turpentine in stimulating power. I have not seen 
any trials of the fixed alkalies, but have heard of their 
failing like every thfng else. 

The consecutive febrile state is to be treated like 
fever under any other circumstances. There is 
usually very great cerebral oppression, indicating 
blisters to the nucha and shaving of the head. Small 
doses of calomel are also beneficial. The greatest 



THE CHOLERA. 193 

care is required in avoiding errors in diet during con- 
valescence. 

Dissection has hitherto revealed nothing which ac- 
counts for the formidable train of symptoms whose 
cause is sought. There is an accumulation of blood 
in all parts of the venous system, with the curious ex- 
ception of the vena portse and its branches. The en- 
gorged state of the lungs, and the oppressed respira- 
tion during life, point to the respiratory system as 
principally suffering, either idiopathically, or symp- 
tomatically of some altered condition of the nervous 
system. 

Prophylaxis. — The attack is generally preceded by 
diarrhea, varying in duration from six hours to three 
days : t hk> is the critical time for successful treatment. 
I have found pills prepared according to the following 
Ibrumla very successful in arresting the diarrhoea: 

H. Gpii,gr. xv. 

Hydrarg. Submur. 3J. 

Pulv. Bacc. Capsici, 3iss, vel. 3ij. 

Confec. Bosrc, q. s. ut fiant pil. Ix. As they are 
in constant request when visiting the abodes of chol- 
era patients, it is convenient to carry a box in the 
pocket. One or two may be given every three hours 
until relief is obtained. They produce a state of con- 
stipation which continues two or three days, and 
which it is quite unnecessary to remedy by laxatives, 
as the bowels soon resume their natural functions. 
When there is much pain of abdomen or griping at- 
tending the diarrhoea, it is alleviated by hot fomenta- 
tions or a sinapism. 

During the prevalence of cholera, there are observ- 
ed among persons otherwise healthy, various anoma- 
lous affections of the nervous system, as spasms and 
17 



194 TREATMENT OF 

cold sensations of the hands, feet, and legs, peculiar 
thrilling sensations of the extremities of the fingers 
and toes, and a feeling of great anxiety in the praecor- 
dial region. 

I am, Sin, 
Your obedient servant, 
Henry Ogden, M. D. 
Sunderland, Jan. 14, 1832." 

Dr. James Adair Lawrie, Professor of Surgery, 
Andersonian University, and Dr. David B. White, 
one of the physicians to the Gateshead Dispensary 
and Cholera Hospital, have also given to the public 
the results of their experience in cholera. Their 
views respecting the treatment of the disease are thus 
given in the Medico-Chirurgical Review, for April, 
1332: 

" Both Dr. Lawrie and Dr. White insist on the 
necessity of attending to the premonitory or diar- 
rhoeal stage. Dr. L. recommends the patient to be 
put to bed, kept warm, and to have a flannel band 
round his abdomen — then to take half anlounce of cas- 
tor oil with fiftee n or twenty drops of laudanum, and, 
after this has operated, thirty drops of laudanum, or 
one grain of opium. Saline and drastic purgatives 
are strongly deprecated. If the discharges continue, 
the opiates must be repeated with caution, and if two 
or three grains of opium fail, Dr. L. would open a 
vein, and in every case apply a sinapism or blister to 
the abdomen. If the above measures fail, and col- 
lapse threaten, he advises a mustard emetic, to be fol- 
lowed up by twenty grains of calomel, and as much 
laudanum or opium as the patient will bear. Opiate 
enemata deserve trial, and if opium has been pushed 



THE CHOLERA. 195 

as far as is safe, mucilaginous enemata should be 
thrown up with a Jukes' syringe. 

Dr. White remarks, that in some cases, not diar- 
rhoea, but obstinate costiveness prevails, after a longer 
or shorter duration of which, the disease suddenly 
appears. For this costiveness he seems to recom- 
mend a pill of scammony, jalap, calomel, and aloes. 
In this stage Dr. W. also advises the washing of the 
body with warm water, and subsequent friction with 
coarse cloths. He seems to think that personal filth 
is a great predisposing cause. He orders his patients, 
on their retiring to bed, the lavation and rubbing- 
then the pediluvium and a pill of cal. prep. gr. vi. 
opii. gr. j. — in the morning castor oil and laudanum, 
or pulv. rhei, 3ss. zinzib. pulv. gr. viij. to be repeated 
if necessary. 

Treatment of the Acute Stage. Dr. Lawrie re- 
commends a mustard, or salt, emetic, the former not 
too strong ; he doubts their efficacy or safety when 
profuse vomiting of colorless fluid is a prominent 
symptom. As soon as the emetic has been swallow- 
ed a vein should be opened. His experience is in 
favor of bleeding, and, as a general rule, the earlier 
the better. In some cases it undoubtedly appears to 
do harm, and it is difficult to explain this discrepan- 
cy of effects. We may say that the earlier the better, 
that it is more safe in the robust, probably more safe 
after collapse than when it is just on the point of be- 
ing established, and in the moderate than in the very 
severe cases. Such are Dr. L's notions. After 
these means we are to give a large dose of calomel 
and opium, to a stout man thirty or forty grains of the 
former within two hours. Of opium a large dose 
should be given at first with the calomel, and its re- 



196 TREATMEMT OF 

petition should be regulated by circumstances. Dr. 
L. strongly recommends counter-irritants to the 
throat; neck, spine, to the latter indeed the cau- 
terizing-iron. Stimuli should also be given internally 
if the stomach will retain them. 

Dr. White thinks blood-letting has been too univer- 
sally recommended. When vascular debility is very 
apparent he would not employ it, but when the pulse 
retains its force or rises during the operation, it is ad- 
vantageous. Bleeding, too, he thinks an admirable 
sedative, when great mental excitement prevails., 
He recommends the exhibition of cold water slightly 
colored with brandy. He speaks well of cupping, 
external warmth, frictions for the spasms. He has 
found nothing but disappointment from the exhibition 
of stimulants 5 but speaks very highly of large injec- 
tions of warm water. 

Stage of Collapse. Dr. L. recommends warmth — 
an emetic as before — the abstraction of a few ounces 
of blood while the pulse can be felt in the brachial 
artery— then warm injections of beef-tea with brandy 
and laudanum — counter-irritation — diffusible stimuli 
— cold drink in its most agreeable form, for which, 
and for which only, the patient craves. All fluid 
should be given in small quantities at a time; thin 
arrow-root or beef-tea often remain on the stomach 
when nothing else will. External warmth is to be 
maintained by stoves or large fires in the room. 

' A very simple method of heating a room, is an 
iron tube bent at its centre, the bent part converted 
into a small reservoir or worm. The reservoir is put 
into the fire and heated red hot ; to the one end of 
the iron tube another of tin or of patent cloth is at- 
tached, and to its extremity a pair of large bellows. 



THE CHOLERA, 197 

Air is thrown into the reservoir or worm, becomes 
heated, escapes at the opposite end, and is diffused 
through the room. One of this kind has been describ- 
ed to me ; the principle might easily be improved into 
a very efficacious means of raising the temperature 
of a room or bed, to any required height. The air- 
bath is another means of applying heat to the surface 
generally, but air being a bad conductor must not be 
trusted to alone. Tin cases containing hot water, 
light and shaped to apply to any part of the body, are 
very useful for applying heat locally; to the same 
class belong bricks, bags of heated salt or sand, hot 
plates, and many others. My friend, Mr. Brady, at 
Gateshead, was in the habit of using bran mashes, 
for communicating heat to the surface, with good 
effect. A quantity of bran is put into a tub, and 
boiling water poured into it in such quantity as 
merely to moisten it. It is then thinly spread in a 
bag sufficiently large to cover the whole body, and 
applied from the neck to the feet. It must not be 
applied too hot. This mode has the advantage of 
retaining the heat long, and is one of the best forms 
of moist heat which I know. If we wish, to excite 
the surface powerfully, we may add spirits of turpen- 
tine to the bran. It is exceedingly difficult to pre- 
vent the patient from tossing in bed, withdrawing 
himself from the heated bags, and throwing off the 
bran and bed-cloths. A nurse must be constantly 
beside him to prevent this as much as possible.' 

When the perspiration is profuse and cold, it should 
be carefully wiped off with dry hot towels, and after- 
wards camphorated or ammoniated oils should be 
long and diligently rubbed on those parts where irri- 
tants are not applied. When the head and face re- 
17* 



198 TREATMENT OF 

main deadly cold while the trunk and limbs are heat- 
ed, it is a very bad symptom. It is singular that the 
patient dislikes the application of heated cloths, and 
begs for free cool air. Dr. Lawrie recommends the 
employment of galvanism, the agent to which we our- 
selves directed attention in our last number. He ad- 
vises the application of the wire along the course of 
the eight pair of nerves in the neck, and over the 
region of the heart and stomach, Dr. L. would be 
inclined to give calomel in moderate doses along with 
the stimuli. Other means were employed with 
doubtful results. Oxygen gas was given both by the 
mouth and by injection, but with very little benefit. 
It was recommended to throw large quantities of 
heated air into the bowels, but Dr. L. does not seem 
to have seen it attempted. Stimulating enemata of 
sp. terebinth, and mustard were used by some ; they 
frequently produced irritation of the rectum and 
bloody stools; Mr. Baird, of Newcastle, used the 
tobacco enemata in one case of collapse with seem- 
ing benefit. Dr. L. tried it in two cases: in one it 
did no good, in the other it appears to have done 
harm. We think it a dangerous remedy, not war- 
ranted by principle and reasoning. When dogs are 
poisoned by tobacco injections the symptoms are pre- 
cisely those of cholera : — purging, vomitings cessation 
of the pulse, complete collapse. How such an agent || 
should be likely to prove beneficial in cholera, we " 
cannot so much as imagine. 

Dr. Lawrie observes, that in the stage of collapse 
nature does and will do nothing ; perhaps the express- 
ion is too strong. If the following fact be one, it is 
instructive. A medical man left a cholera patient, 
saying that he could do no more for him, and that he 



THE CHOLERA. 199 

must die ; another surgeon passing by accident, was 
asked to see him, worked hard for four hours, and 
saved him! 

Dr. White's remarks on the treatment of this stage 
are brief. 

? I have found the simplest, the most successful 
treatment : — the calomel and opium, the carbonate 
of ammonia, warm injections, stimulants as cordials, 
friction where necessary, and warmth, essentially of 
a dry kind; worsted stockings filled with hot sand, 
as I learnt from the practice of Mr. Knaggs of Gates- 
head, is admirably adapted for this purpose. 

To allay the vomiting, as in the former instance, 
effervescent draughts, &c. should be used. A most 
salutary and speedy application, is by laying over 
the stomach pledgets of linen, dipped in boiling water. 
Whatever may be the plan adopted, all unnecessary 
disturbance to the patient should be avoided. The 
death-bed is often rendered more agonizing by the 
mistaken, but well-intentioned, zeal, the benevolent 
officiousness of inexperienced practitioners. An 
enema, consisting of a warm infusion of tobacco, half 
a dram to a pint, has been recommended by Mr. 
Baird. I have seen recovery in two apparently hope- 
less cases, in which this remedy has been employed.' 
Dr. W. makes a remark which is highly deserving 
of attention. When cholera first rages its inveteracy 
is greater than at a subsequent period, and remedies 
which utterly fail in the first instance, acquire a re- 
nown and celebity when nature herself is at work to 
assist them. Dr. White speaks slightingly of mustard 
emetics ; he has never seen them serviceable in the 
collapsed stage, whilst in some instances they were 
incontrovertibly mischievous. 



200 TREATMENT OF 

' Prior to death, when it takes place during this 
stage, the disease sometimes assumes a form, well cal- 
culated to deceive those not acquainted with its char- 
acter. The pulse rises, the skin becomes warm and 
covered with perspiration, the patient expresses his 
relief, and, perhaps, his full anticipation of recovery : 
in an hour or two, all is over. The blueness, so pe- 
culiar to this disease in other countries, has not been, 
by any means, a general characteristic in this. In 
not one instance in ten, has it assumed that form. 
The skin of the hands and face often becomes of a 
brownish hue. In the most deadly form of cholera, 
there is a tone of voice, a wail, which once heard, can 
never be mistaken ; to him upon whose ear it has 
fallen in the accents of anguish, it can never be for- 
gotten ; I have always found it the certain prognos- 
tic of death.' 

Here we see that the blue color, the true blue, as 
the papers sarcastically term it, is not present in one 
case in ten. Yet this true blue is one of the pathog- 
nomonic symptoms that the ultra contagionists, that 
is, the thick-and-thin importation and nova pestis 
party hold by as their sheet anchor. But what signify 
facts ? At the time we are writing, the 25th of Feb- 
ruary, the epidemic is stealing over this metropolis.* 
We have seen many, indeed most of the cases that 
have hitherto occurred, but in no one instance could 
our eyes, unassisted by the spectacles of quarantine 
notions, and the mists of party feeling, discern any 
shade of blueness. That color is seen in its deepest 
dye in the visages of contagionists and sycophants.f 

Treatment of the Rallying Stage. In this, the sur- 

* London. t Reviewer. 



THE CHOLERA. 201 

geon is to watch nature ; to prevent recurrence of 
collapse on the one hand, and ward off congestions of 
the head and viscera on the other. The first is avoid- 
ed by externa] warmth, and by giving warm arrow- 
root in moderate quantities, the second, by small 
doses of calomel, taking care not to push it too far. 
The head should be shaved ; when the stomach con- 
tinues very irritable, blisters and effervescing draughts 
with small quantities of laudanum are very benefi- 
cial. 

Treatment of the Febrile Stage. When congestions' 
do not occur, a few grains of calomel and small doses 
of castor oil and acidulated drinks are generally suf- 
ficient. In common cases, the lancet is unnecessary, 
and when congestion threatens, it is a hazardous 
remedy. Dr. L. mentions a case in which it appear- 
ed to re-induce collapse. When congestion threatens 
the head, which is the chief danger, blisters to the 
scalp, or nape of the neck, preceded by leeches and 
cold lotions, and followed by calomel and mild pur- 
gatives, are proper. The same principle applies ta 
abdominal congestions. The patient often dies with 
the worst form of typhus. 

Dr. White remarks in this stage the redness of the 
tongue ; he thinks this is the'most proper time for the 
employment of the lancet with proper precautions ; 
when there is obstinate greenish sickness he has seen 
great benefit from the salt emetic, repeated till nothing 
but the solution is rejected. He draws attention to 
the peculiar tendency to affection of the head, insid- 
ious in its progress, and fatal in its tendency.' 5 

Mr. Greenhow, of New castle, Member of the Roy- 
al College of Surgeons in London, in a late work upon 



202 TREATMENT OF 

the cholera as it appeared in the towns of Newcastle 
and Gateshead, lays down the following indications 
in the treatment of this malady. 

"1. The necessity of allaying irritation in the ner- 
vous expansion of the stomach and bowels. 

2. To excite the vascular system, and to restore 
animal heat. 

3. To restore the suppressed secretions. 

4. To obtain healthy evacuations from the bowels 
and kidneys. 

5. To moderate re-action, and obviate congestions, 
local determination, or organic inflammation. 

The first indication may be considered as common 
to the first and second stages of the disease, the three 
succeeding ones relate principally to the second stage, 
and the last indication is peculiar to the third stage of 
cholera. We will consider them in the order of their 
arrangement. 

If the stage of collapse have not yet established it- 
self, and if witlvbilious diarrhoea, the patient com- 
plains much of nausea and occasional retching, the 
matter ejected consisting principally of undigested 
food, we shall probably find a dose \ of ipecacuanha* 
with or without antimony, answer the purpose, or 
even copious draughts of warm water will suffice to 
wash out thoroughly the contents of the stomach. 
Should the patient complain at this time of vertigo, 
head-ach, or pain in the abdomen, with an accelera- 
ted pulse, the greatest relief will arise from a full 
bleeding, proportioned, however, to the strength of 
the constitution, the effect produced upon the pulse 
and the urgency of the symptoms. As the blood 
flows, the pain in the abdomen and head will be re- 
lieved, and the pulse will become slower and softer : 



THE CHOLERA. 203 

a manifest diminution of gastric irritation will also 
result from it." 

" When the stage of collapse has set in, we require 
stimulants — the mustard emetic —after this doses of 
calomel and opium, the latter not in too large quanti- 
ties, grain doses being generally sufficient — internal 
stimulants, brandy perhaps the best — copious warm 
stimulating injections into the intestines — external 
heat and friction. Mr. Green how makes the follow- 
ing remarks on the application of the latter : — 

' For the accomplishment of this purpose, one of the 
first things to be attended to, is to clothe the person of 
the patient in a large body-dress or shirt of thick flan- 
nel, and to envelope him, when laid in bed, in an am- 
ple supply of warm blankets ; heated bodies of any 
convenient description, should also be constantly ap- 
plied to the extremities, to the spine, and to the pit 
of the stomach and abdomen. Various contrivances 
have been made use of for applying heat to the sur- 
face. To the employment of the warm or hot bath 
it has been objected, that the exertion and fatigue at- 
tendant on its use, are likely to be more injurious by 
the exhaustion they would occasion, than could be 
compensated by any benefit arising from the general 
application of heat that would be obtained; and al- 
though warm baths have been found beneficial in 
India and on the Continent, in this place they have 
not been resorted to in the treatment of cholera. Nev- 
ertheless, I know a gentleman who suffered from chol- 
era at Archangel, during the last Summer, and who 
was restored from a state of complete asphyxia by 
being kept in a warm bath, of a high temperature, 
for an hour and a half. I am sufficiently sensible of 
.the necessity of preventing the patient from using any 



204 TREATMENT OF 

voluntary exertion, and more especially of strictly 
preserving the horizontal position during arrested cir- 
culation, having witnessed the fatal effects of a de- 
parture from this rule in the almost immediate death 
of the patient ; but 1 am yet inclined to believe, that 
the prejudice against the use of the warm bath is 
greater than necessary. The patient might surely be 
placed in, and removed from it, with such quickness 
and so little disturbance, as to obviate the objections 
that have been made to it. It is, however, for the 
most part, in hospital practice only, that the employ- 
ment of this means of restoring the defective heat of 
the system, could be available, since the houses of the 
poor are seldom provided with the requisite conven- 
iences for preparing a heated bath. Various ma- 
chines have been invented for introducing heated air 
into the bed of the patient, but the experience of our 
hospitals has proved their inefficiency, I believe, with- 
out an exception, and their use has been almost en- 
tirely laid aside. Mr. Wood, a gentleman of consid- 
erable ingenuity in this place, has contrived an appa- 
ratus consisting of several thin bottles of tinned iron, 
which are adapted to the extremities and other parts 
of the body in such a manner, that when filled with 
warm w'ater, and cased in bags of flannel, they have 
been found to answer in a satisfactory manner, the 
purpose of the external application of heat ; but on 
ordinary occasions, w T e must content ourselves with 
heated irons, bricks, bags of sand, flannels, &c. 

Unless a considerable quantity (of the calomel) has 
been already taken, a full dose, -varying from 5 grains 
to a scruple (in truth I believe it is a matter of much 
indifference which) may be given ; and to fulfil the! 
fourth indication — to obtain healthy evacuations from 



roi 






Dh 



THE CHOLERA. 205 

the bowels and kidneys— the exhibition of a purga- 
tive may soon succeed. Castor oil, 1 am disposed to 
believe, will be found the most effective and least ir- 
ritating medicine of this class, but should it fail, other 
means ought soon to be resorted to, and injections 
may be employed to assist their operations. Calo- 
mel and jalap, or a purgative infusion with carb. and 
sulph. of magnesia, may be given at intervals until 
discharges are obtained from the bowels ; these will 
probably be found feculent and bilious, and, for the 
present, we may consider our patient safe, especially, 
if, as usually happens, urine be discharged at the 
same time.' 

• It is in this, as in most other violent diseases, w 7 hat 
we do not ourselves superintend is inefficiently per- 
formed by nurses. If the medical man has any care 
for his patient in the stage of collapse, he will hardly 
quit him till he has either recovered from, or past all 
earthly hope. When the stage of fever has set in, the 
farther use of stimulants is most pernicious, ' the anal- 
ogy between this and the various forms of continued or 
inflammatory fever, may be considered as complete,' 
and the treatment must be of a corresponding descrip- 
tion. Its leading feature is usually organic inflam- 
mation, and the treatment must be conducted on gen- 
eral principles. It is at the commencement of this 
stage, that Mr. G. warmly recommends bleeding, < a 
powerful remedy — powerful when employed at the 
auspicious moment — powerless when used at a later 
or an earlier period.' 

' When we are fortunate enough to be called to a 
patient before the pulse fails, still more before the se- 
rous evacuations commence, when he is suffering 

from the symptoms which so frequently occur in the 
18 



206 TREATMENT OF 

first stage — nausea or vomiting, purging of bilious 
matter, vertigo, head-ach, probably injected conjunc- 
tivae, pain in the abdomen or at the pit of the stomach, 
with a quick, sharp, or oppressed pulse, and probably 
occasional cramps in the legs — a full bleeding will 
be found of the greatest benefit, not only in relieving 
the existing symptoms, but in averting the impending 
horrors of the second stage of the disease ; this effect 
may perhaps yet be produced, although the pulse 
have become feeble and still more opppresed, but 
not when imperceptible. In such cases it expands 
and increases in strength and freedom as the blood 
flows. If, however, asphyxia, coldness and blueness 
of the extremities have fairly established themselves, 
the attempt to obtain blood is vain ; thickened and 
stagnant as it is in the vessels, it cannot be made to 
flow, and if a few ounces be squeezed from the orifi- 
ces, hangs from them in long strings, accumulating 
like stalactites, without producing any beneficial ef- 
fects. On the contrary, it fatigues the patient, expo- 
ses him to the prejudicial influence of cold, and sus- 
pends for a time, more efficient means of relief. I 
must, therefore, hold bleeding in these circumstances, 
to be inadmissible, principally because it cannot be 
accomplished ; and the attempt injurious, since it di- 
verts attention from measures of less doubtful utility, 
because they are really practicable.' 

Upon this passage, Dr. Johnson remarks, 'From 
what we have seen of the disease now in London, 
from the results of examination after death, from what 
we have read of the practice in the north, from the 
conclusion derived from reasoning on general princi- 
ples, and from our experience in India, we do most 
conscientiously believe, that the remedy which we 



THE CHOLERA. 207 

first proposed and employed for the cholera in Indos- 
tan, we mean blood-letting, is, after all, one of the sa- 
fest and best, when judiciously timed and applied. 5 

' The chances of recovery,' says Mr. G. ' in cases 
of cholera., must depend upon the stage oft he disease; 
the duration of the attack before the employment of 
judicous remedies, its severity, and upon the oge, con- 
stitution, and previous state of health of the patient. 

It has been seen that when the patient comes under 
treatment in the early stage of the disease, before the 
pulse and animal heat fail, his recovery may be cal- 
culated upon w T ith much certainty. The abstraction 
of blood if indicated, a single of dose of calomel and 
opium, succeeded by castor oil, will frequently re- 
store him to health in a few hours. 

When the more formidable symptoms of the second 
stage have set in with great severity, the chances of 
recovery are, in all cases, very precarious ; and if the 
constitution be enfeebled by previous disease, or old 
age, the case may be considered as nearly hopeless. 
In childhood, youth, and the vigor of life, an active 
and diligent use of remedies will often be attended 
with complete success ; and it is in these cases that 
we are stimulated in our exertions by the satisfaction 
of witnessing their utility. The warmth of the body is 
in the first place restored ; the pulse becomes percep- 
tible, it increases in strength and volume, and the nat- 
ural color of the skin generally returns ; the secretions 
become re-established, and the patient is brought in- 
to a state of safety ; for, with vigilance, the succeed- 
ing symptoms may, with much certainty, be obviated. 
All this, however, does not go on uninterruptedly. 
The patient has many uneasy sensations during his 
recovery from the stage of asphyxia; he becomes 



208 TREATMENT OF 

restless, complains of pain at the stomach, with oc- 
casional nausea, or even vomiting. Still there is re- 
stored action of the heart and arteries, the functions 
of life are going forward, and we may fairly antici- 
pate that, under judicious direction, they will lead 
to the entire restoration of the patient. But when 
the restorative efforts are opposed by previous or- 
ganic disease, general feebleness of constitution, or 
the worn* out energies of age, we must not calculate 
too confidently upon any imperfect re-action that may 
be induced. Heat and pulse may return, the former 
perfectly, the latter in degreee only ; the spasms and 
watery discharges may cease ; something approach- 
ing to natural excretions may even take place, and 
yet the patient will not unfrequently sink ; not from 
violent re-action, or the development of local inflam- 
mation, but from want of energy in the vital powers 
to carry forward the attempts at restoration which 
seem so happily commenced. 

The danger of the case is by no means dependant 
upon the quantity of matter discharged from the 
stomach and bowels. In some of the worst cases, 
this is not very considerable, and in some of the most 
successful, it has been very great. Neither is cramp 
or spasm a certain criterion. Many fatal cases have 
occurred, wherein it was nearly entirely absent, or 
soon ceased. The great danger appears to arise from 
imperfect or suspended circulation. Let this be re- 
stored fully, and the rest is within our control. On 
this circumstance, mainly, then, will rest our judg- 
ment as to the probable result of our efforts, though 
all the concomitant circumstances of the case must 
be taken into the account." 



THE CHOLERA. 209 

Dr. Kirk, of Greenock, whose account of the symp- 
toms of the cholera asphyxia we have already quo- 
ted, and who appears to have been indefatigable in 
his inquiries as to the best method of treating the dis- 
ease, thus alludes to the subject : — 

u The question as to the general propriety of blood- 
letting, is at the same time a very difficult and impor- 
tant one. A great proportion of British practition- 
ers, who have treated the disease, have shown a par- 
tiality to it. The reasoning leading to the practice 
is specious, but I fear superficial. We are told, take 
away a portion of the circulation, and you relieve 
it of a part of its load, and give nature freer play ; we 
unload the system, and induce the surcharged ves- 
sels to put on a new and livelier action. Now, in 
accordance to the theoretical views 1 have ventured 
to adduce upon the disease, it will be seen, that a re- 
turn to healthy circulation will not result from ab- 
stracting, or adding, a portion of the circulating mass. 
The cessation of arterial action is not dependent on 
the state of the fluids, but on determinate derange- 
ment in the sensorial power ; the result of a morbid 
poison, by which the machinery of the circulation has 
been impaired in its healthy action. I speak of the 
stage of collapse, or the period which immediately 
precedes it. In that stage, 1 can see no advantage to 
result from withdrawing a small portion of blood ; and 
in 99 out of a hundred cases, a small portion can only 
be withdrawn. The sensorial derangement will not 
be relieved by the evacuation, and the system, already 
depressed by excessive discharges of the most debili- 
tating kind, will be plunged still deeper into that fatal 
weakness which is the principal characteristic of 
this disease. The evacuations of advanced cholera, 
18* 



210 TREATMENT OF 

are not the discharges of alvine matters, or of the or- 
dinary fluids of the bowels. They are largely compo- 
sed of the serous and saline parts of the blood ; and 
consequently produce a destruction of the strength, as 
swift as it is complete. 

1 entertain the highest respect for some of the em- 
inent supporters of bleeding ; but, after conscientious 
attention to the subject, and watching the practice in 
various hands, I feel myself bound to declare my con- 
viction. If the patient is attended within an hour or 
two of the attack, and the pulse is strong, and the ar- 
terial system in a state of excitement, and he is yet un- 
reduced by the debilitating dejections of choleric di- 
arrhoea and vomiting, bleeding is demanded by the 
ordinary rules of our art, which indicate venesection 
as the best mode of relieving arterial irritation and high 
action. But when was it proposed till the present 
day, to relieve a condition of the extremest depression, 
and of no arterial excitement, by the abstraction of the 
principal vital fluid? The blood is unnaturally thick- 
ened, to be sure, grumous and probably carbonized ; 
but will the removing of a small column of venous blood 
change the condition of the rest of the sanguineous 
fluid, or give energy to those nerves which, under a 
poisoned influence, have ceased to perform their im- 
portant functions, of giving life, action, and energy to 
the whole system ? 

1 grant, most freely, that in the first and second pre- 
monitory stages, bleeding may do good ; for then the 
arterial system is in a state of excitement, and the poi- 
son has not fixed its deadly fangs on the powers of life 
itself. But then, even, I would be cautious. A de- 
pressing influence is in the constitution, which may 
every hour develope itself as most deadly in its power 






THE CHOLERA, 211 

and tendencies. Let there be withdrawn only so 
much as to diminish somewhat the energy of the cir- 
culation ; but do not trench on the vis vitas. Ever 
recollect that a poison is within which nature is strug- 
gling to oppose, and by instituting increased action, 
seeks to free herself from her insalubrious oppressor. 
Nor is this the language of theory only. I have seen 
many attempts at bleeding in collapse, but never to 
any other purpose but apparent harm : and in numer- 
ous instances of the last stage of the premonitory symp- 
toms, 1 have thought collapse induced by injudicious 
bleeding. I was favored w T ith the perusal of a case 
by a medical friend near Musselburgh, which, under 
appropriate treatment, and without bleeding, I have 
no hesitation in saying would have done well ; but 
from the apparent success of another, and a published 
case, which had excited a good deal of attention, my 
friend thought proper to repeat the practice, and lost 
his patient. But this solitary case need not be quoted ; 
for in the practice I have seen, I have bitterly to la- 
ment the injudicious use of the lancet in severe pre- 
monitory cases. 

There is still a question among practical men, if a 
state of excitement always precedes the attack. I 
think it does. In all cases I have had it in my power 
to observe from the first, it has done so. The poison of 
cholera in this country does not seem sufficiently 
energetic to destroy the constitution in a moment, as 
it is said it sometimes does in India. Nature struggles 
for emancipation, generally for days together, and in- 
stitutes new actions, and various discharges, to relieve 
herself of her load. It is in this condition that the in- 
judicious practice of giving a mustard emetic is fre- 
quently resorted to. If an emetic is indicated, the 



212 TREATMENT OF 

symptoms giving reason to suppose that sordes are to 
be discharged from the stomach, common salt and wa- 
ter will be the best emetic ; it will not irritate and 
stimulate. But in general, copious draughts of warm 
water will answer the purpose better. Upon the 
whole, I entertain much doubt of the propriety of 
emetics in the advanced stages of cholera. 

I come now to consider the important subject of the 
use of calomel in this disease. All British practition- 
ers, who have treated the complaint, have resorted to 
this chymical preparation. I am not sure that in gen- 
eral, calomel is prescribed upon any principle ; but 
rather empirically, and without very definite conclu- 
sions. I entertain no doubt of the propriety of its use, 
and have for the advantage of those who have not seen 
much of cholera, given in the appendix f numerous ca- 
ses illustrative of the use of it. Perhaps, in our present 
knowledge of the nature of the disease, we must speak 
with caution in endeavoring to explain the rationale of 
its beneficial action. But this is clear, that scarcely any 
substance will lie more agreeably on the stomach than 
calomel, in this disease ; for I have been surprised to 
see repeated doses of calomel retained, when all other 
things were vomited. Dr. Lawrie says that he knows, 
from personal experience, that calomel will remain on 
the stomach when nothing else will ; and my experi- 
ence of it has been exactly to the same purpose. 

Thus there is no objection to its use, on the score of 
local irritation ; and from its action on the system as 
an active mercurial, we may expect it to expedite the 
return of the secretions of the bowels, liver and kid- 
neys — which, when obtained, our patient is safe. In 
England, I seldom saw ptyalism produced by calomel ; 
but here, where we have the advantage in our hospit- 



THE CHOLERA. 213 

als of a capital system of heating, our collapse wards 
being seldom under 75 deg. Fahrenheit, all the cases 
which recover are decidedly under the influence of 
mercury. Thus does the effect of this excellent appli- 
cation of heat not only act mechanically in restoring 
that which nature has ceased to supply, but it also gives 
increased effect to the appropriate medicines. Even 
after enlarged experience in this disease^ I think calo- 
mel will retain its place among the remedies used for- 
ks removal. 

Opium is the next remedy of importance to which 
we have to allude. This powerful drug has been too 
indiscriminately used, in the treatment of cholera ; and 
the scientific practitioners with whom I have had inter* 
course, now use it with much greater caution than 
they did when they commenped the treatment of this 
disease. In the appendix will be found several cases, 
explaining the mode in which the English practition- 
ers now use it. 

Several considerations press upon us in reflecting 
on the use of this drug in cholera. With what inten- 
tion do we administer it ? It is a stimulant. But have 
we not pure stimulants of a kind which do not par- 
take of its narcotic nature, and which will give excite- 
ment, and act as cordials, without either a depressing 
or narcotic effect upon the nervous system? Upon 
the whole, it is my opinion that the use of opium ought 
to be confined to its effects in obviating spasm, and 
w T hen spasm does not exist, if a stimulant is indicated, 
the pure vinous diffusible stimuli seem more appro- 
priate. We must not forget, however, how useful it 
may be, from its soothing and astringent qualities, in 
moderating the discharges ; but let us also remember, 
that more than half the deaths of cholera are in its final 



•214 TREATMENT OF 

congestive fever, and that the principal symptom of 
that fever is congestion of the head : and consequent- 
ly that the accumulated effects of a narcotic stimu- 
lant is much to be dreaded and avoided. 

I would then, very earnestly expostulate against 
any thing like a liberal use of this drug in the disease ; 
and would only recommend it in cautious doses, for 
the purpose of moderating the discharges and subdu- 
ing spasms. 

Brandy comes next in the list of the remedies em- 
ployed in cholera ; and as in all cases of collapse I 
have seen treated by others it has been employed, I 
must inquire into the propriety of its use, with some 
caution and accuracy. Does the pathological histo- 
ry of this disease indicate the propriety of the free 
use of a diffusible stimulant ? 1 appeal to all those 
who have witnessed dissections of cholera, if I am 
not correct in stating that the great and leading facts 
elicited on the examinations, w r ere, that the import- 
ant viscera, and even the brain, showed most demon- 
strably that they had been subjected to high action. 
I have witnessed the dissection of six bodies in the 
disease. In all of these, demonstrations of inflam- 
matory action were most clearly evinced, and inflam- 
mation, too, of the nerves, plexuses, and membranes, 
which could not be disputed ; and that man must be 
hardy indeed, who can look at these details, and say 
that in its early stages, this is not a disease of inflam- 
matory action. In the early stages, this action can 
be subdued; and it is this important fact to which 1 
have labored to call the attention of the country. But 
the organs principally affected, the gastric ones, it is 
known to every tyro, most unhappily do not bear 
such free bleedings as other important inflammations. 



THE CHOLERA. 215 

I make this remark, because it may be urged, why 
do you give us so many cautions about blood-letting, 
when you acknowledge with the same breath, that it 
is a disease of inflammation ? I answer to this, that 
it is only so in its early stages. Pass the bourne of 
the second premonitory stage, and the evil is consum- 
mated, You have no longer a case in which inflam- 
mation alone is to be considered, but one in which 
all the functions of nature have lost their powers ; and 
where, alas ! you can only temporize, and look on, 
and watch for, and assist the healing power of na- 
ture. 

Is brandy, then, a remedy in any stage of this dis- 
ease ? In the report, I have permitted its use in small 
quantities, not venturing to make an innovation on 
the established practice by avoiding it altogether ; but 
it is now my duty to say decidedly, that the cup of 
brandy you perpetually see at the head of the chole- 
ra patient, cannot be given him innocuously. His 
bowels are in general in a state of positive high action 
and inflammation ; so are his brain and spinal mar- 
row, and so are even the vascular systems of the 
greater nerves. What do we gain by brandy ? We 
obtain a temporary diffused excitement from its sti- 
mulant powers, and a kind of soothing of the sensa- 
tions from its narcotic influence ; and can these effects 
produce any change in that morbid condition of the 
system, which we have seen, is cause of cholera ? 
I will be told that brandy, by the mouth and by ene- 
mata ? have often and evidently done good. Let, then, 
this be its restricted use. Never give it, either in the 
one mode or the other, but in those extreme cases of 
disease where even the temporary fillip to nature, 
whichit can give, maybe courted ; and though it is 



216 TREATMENT OF 

to come into contact with and irritate diseased tis- 
sues, still perhaps, in these extreme circumstances, 
its use may be indicated. But in the premonitory 
stages, while action, sometimes high action, still ex- 
ists, — and when we know many vital parts are high- 
ly irritated, and that our business is to subdue that 
action,— I never see the glass of brandy at the pa- 
tient's head without a shudder/ It is a fact that in- 
telligent practitioners are every day becoming more 
and more cautious of the use of this stimulant. I 
feel that I have ventured far in this wholesale con- 
demnation of it; but I confidently anticipate the 
decision, in my favor, of those who are to come after 
me, inasmuch as my views are certainly founded in 
the ascertained pathology of the disease. When 1 
think a cordial strongly indicated, I am in the habit 
of preferring the pure wines, the irritation to the in- 
flamed tissues, from their use, being less to be dreaded 
than the sharp and naked points of alcohol. 

The next great remedy employed in the cure of 
this disease, is the application of heat. The restora- 
tion of the natural heat, so totally lost in the collapsed 
stage, is suggested by the most natural and evident 
reasons. The only question is, what is the best 
mode of effecting this object ? I shall first allude to 
the most approved modes of applying heat in hospital 
practice. In this respect I thought the English hos- 
pitals very deficient. One of the Edinburgh hospi- 
tals is admirably managed, by a plentiful supply of 
heated air, and by steam heated mattresses. The 
Vennel hospital of Greenock is heated by flues com- 
municating with two furnances, which keep the 
whole wards constantly at a temperature of from 65 
to 15 degrees Fahrenheit. We have also a plentiful 



THE CHOLERA. 217 

supply of tin vessels, fitted to the shape of the various 
parts of the body — the abdomen, the arms, the legs, 
and the chest — by which the heat of warm water is 
easily conveyed to any of these parts. We have 
also always in readiness a plentiful supply of heated 
sand for sand bags. The sand bags are in general 
made too large, in consequence of which they are 
heavy and oppressive. They should be flattened 
bags, and contain only a thickness of an inch and a 
half of sand. 

The advantage of the general heating of cholera 
wards is prodigious. 1 have already explained how 
much more efficient it makes the operation of the 
mercurial medicines. We have never used the air 
baths here — perhaps because 1 entertain the idea that 
■the application of heat by this slow conductor is not 
the most efficient mode of communicating it, and 
that the necessary machine is inconvenient during the 
frequent dejections and vomiting of the patient. But 
in all hospitals a ward should exist, removed from the 
influence of the stoves, in which to place the patients 
when the stage of consecutive fever has effected 
them. In private we have only in our power to use 
the sand bags, tins, and bottles, which c.an be pro- 
cured ; and to take care to procure a plentiful supply 
of bed-clothes, and as large fires as possible in the 
grates. The arms, which are apt in jactitation to be 
^perpetually exposed, should be covered to the shoul- 
j ders with worsted stockings. In the country, where 
' hospitals cannot be procured with stoves, it is aston- 
ishing what perseverance will do in accomplishing 
our purpose by very slender means. In the Appen- 
dix will be found a case, by Dr. Morson, which oc- 

rred in a pitman's house, near Newcastle : and 
19 



218 TREATMENT OF 

which shows very well how much can be done by 
the anxious application of ordinary domestic means. 

All practitioners agree that rubbing is of the great- 
est importance. The excitement which it gives to 
those extreme vessels, which, in this disease, seem so 
peculiarly to lose their tone, indicates its utility, and 
wherever assistance can be procured it should not be 
neglected. When Dr. Mollison of Edinburgh was 
in Newcastle, he cured many cases by energetic and 
continued rubbing, which in all probability would not 
have recovered without it. 

We must next take into consideration the claims 
of counter irritation, to the rank of a valuable reme- 
dial agent in this disease. It is evident from the views 
given, and the facts stated, that counter-irritation is 
clearly indicated in this disease. 1 regret exceeding- 
ly that none of the dissections I have been enabled to 
give, show the condition of the spine in cholera, 
Several friends of mine, who have examined the 
spine, say that the membranes of the spinal marrow 
were inflamed. If this is the case, undoubtedly a 
mode by which inflammatory action will be subdued. 
in this immensely influential part, without at the 
same time debilitating the genera! frame, is of the 
utmost consequence. With this view, I have three 
times used the actual cautery to extremely bad cases, 
but I regret to say in none of them was I successful. 
They were, however, the worst description of cases, 
and do not stagger my belief in the utility of the re- 
medy, if applied to a curable case. The best place 
to apply the cautery seems the lower part of the back 
of the head, particularly where it joins the spine, and 
along the spine itself. Dr. Barry says that Dr. Lange, 
at Cronstadt, by the cautery cured 12 cases out of 



THE CHOLERA. 219 

-14. I am skeptical of this, but am willing to believe, 
L that much advantage may spring from this very de- 
ed mode of counter-irritation. 
The next effectual and most efficacious mode of 
applying a violent irritant, is by placing on the skin 
a cloth newly wrung out of boiling water. This 
mode 1 am in the habit of regularly practising, and 
often with benefit. The blister is raised instantane- 
ously, and in the pains of the hypogastric region, so 
common in this disease, it in general gives relief in a 
few minutes. The next speediest mode is the infu- 
sion of cantharides in strongest ascetic acid, which 
will raise an effectual blister on the scalp, or other 
part of the skin, in a few minutes. 

I know 7 nothing of the effects of galvanism, never 
having seen it adequately applied in this disease. I 
confess that, from the nature of this agent 5 I do not 
expect it will be eventually found useful. The desi- 
deratum in this disease is, not the restoration of vital 
or nervous power, but the cure or alteration in the dis« 
eased state of the nervous power. Now, the proved 
effects of galvanism are only, that it is able, for a 
time, to act as a substitute for the nervous power. 
That it can change unhealthy actions of that pow r er 
we have no fact to convice us. In Ceylon, I under- 
stand, a successful case took place from its use, 
though it was only directed through the lungs ; 
and 1 have sent to the neighborhood of Mussel- 
burgh a powerful galvanic battery, which, 1 un- 
derstand, they have put to use, and speak fa- 
vorably of the results. But 1 have heard of seve- 
ral unsuccessful experiments in this neighborhood 
lately. The remedy seems, at first sight, adapted to 
the disease ; but even Dr. Philip, who might have 
been pardoned though he had hoped too much from 



220 TREATMENT OF 

galvanism, says — ' 1 cannot overlook two circum- 
stances-, which seem, in some degree, to render the 
expectations from it less sanguine. That when the 
nervous power is merely withdrawn, it can supply its 
place, rendering the functions of the organ as perfect 
as when that power was entire, has been ascertained; 
but in the disease before us, we have reason to fear 
that the failure does not consist in the mere loss of 
nervous power, but that the operation of the poison, 
or the organs of that power, diffuses the influence of 
the poison itself throughout the system. The other 
circumstance is, that if it be capable of counteracting 
the offending cause, it is doubtful whether the degree 
in which it can be safely employed is sufficient for 
this purpose. In supporting the function of a vital 
organ, when it is deprived of its nervous power, a 
very considerable galvanic power is necessary. It is 
not to be supposed, in our clumsy mode of applying 
it, that the same degree of power will be sufficient, 
as when applied by nature herself. This objection, 
however, only relates to the degree of benefit to be 
expected from it. The way in which it was employ- 
ed in my experiments, is not the proper mode of ap- 
plying it in the disease before us. Wires, from the 
positive end of the trough, should be applied to vari- 
ous parts of the head, and along the whole course of 
the spine, and wires from the negative end t© various 
parts of the chest and abdomen.' 

Other remedies have been lately proposed, some of 
them by high authority. A distinguished foreigner, 
who visited this country lately for the purpose of at- 
tending to this disease, proposed, and carried into 
effect, the process of injecting the veins with a solu- 
tion of opium. I am not sure of the theory on which he 



THE CHOLERA. 221 

expected relief from this process ; but I have heard 
that he had experienced great benefit from it in te- 
tanic and other violent nervous affections. It totally 
failed, his patients having sunk as if no remedy had 
been used. In Newcastle, where 1 had the pleasure 
of visiting him, I predicted to my friends that this 
would certainly be the result of the experiment. 
The narcotic effect of opium was not to be expected 
to have power to change the altered state of fluids to 
that of health, nor to banish the distressing and mor- 
bid influence settled on the nerves, and slow as the 
circulation is in collapse, it was hardly to be expect- 
ed that his remedy was ever to reach the heart and 
vital parts of the system. In my report to the Board, 
I have stated my conviction of the utility of the tobac- 
co enema ; and I have given in the Appendix a series 
of cases by Mr. Baird, and an essay illustrative of 
his theory in using it. He prescribes it under the 
conviction that cholera is a disease of spasm of the 
important viscera, particularly the gall bladder; and 
that the relaxing effect of the tobacco subdues this 
spasm, gives free play to the powers of life, enables 
the circulation to recommence, and the secretions to 
flow, 

1 am not prepared to dispute this doctrine of spasm 
to a certain extent. It may be one of the effects of 
the poison to cause spasm of the important vicera. 
We see the bladder contracted, even in death, in 
every dissection of cholera ; and in two cases I have 
found the gall duct impervious (in four cases it was 
patent.) This closure must have taken place from 
effusion of coagulable lymph shutting it up iri the first 
high action of the disease. 1 do not think this closure, 

in the dead state, could have been from spasm'. But 

19* 



222 TREATMENT OF 

1 am disposed to attribute the good effects of the to- 
bacco, rather to some specific power in this peculiar 
drug, by which it counteracts the poison of cholera, 
and reduces, by its depressing influence, the high ac- 
tion of the vessels, thus inducing a new and salutary 
action. But be the theory as it may, the practice is 
good, and 1 earnestly invite the profession to give it a 
fair trial. I am convinced, that, after the first stage 
of this disease, the bile ceases to be formed. No 
doubt, we always find the gall bladder full. But I 
believe this filling to have taken place at the com- 
mencement of the disease. There never appears any 
yellowness of the skin in any of the secretions, during 
the progress of cholera, in the perspiration, the urine, 
or the saliva. There is no proof of bilious absorption, 
which infallibly would have existed if bile had been 
formed. 1 believe, in the advanced stages of cholera, 
that a total suspension of bilious secretion takes place 
as well as urine ; and that the reason w^e generally 
find the gall bladder full, is, that the debilitated organ 
cannot propel its contents. The urinary bladder is 
differently situated. It is a voluntary organ to a great 
extent : and 1 have already explained that the volun- 
tary muscles do not seem much under the influence 
of this poison. The last formed portions of urine, in 
the state of health, are thus expelled, and afterwards 
none forms. 1 have stated that coagulable lymph is 
in all probability the cause of the occasional closure j 
of the gall duct. That, in the early stages of this dis- 
ease, this part of the blood (the lymph) is largely sep- 
arated, is proved by the dissection of M'Millan, nar- 
rated in the page 132 of this work, where a lengthened 
polypus was found in the whole course of the longitu- 
dnal sinus, and one in each ventrical of the heart. 



THE CHOLERA. 223 

Iirthe Appendix to Dr. Kirk's practical observa- 
tions on Cholera Asphyxia, the following important 
note is found. 



Sketch of the Practice of three eminent and excellent 
Practitioners of Newcastle. 

1 shall now lay before the public a short summary 
of what I understood to be the treatment of this dis- 
ease, by a very eminent and excellent practical sur- 
geon, Mr. John Fyfe, of Newcastle. At the time I 
was in Newcastle, he had attended 579 cases of 
cholera ; and in all these, he says that collapse never 
came on till after profuse serous discharge from the 
bowels. Mr. Fyfe relies very much on stimulating 
enemata ; and he says that they seldom fail to pro- 
duce reaction in its most salutary form, attended by 
iess congestion than that which followed collapse of 
longer duration, in which stimuli had been withheld, 
or when the most diffusible stimuli had been given by 
the mouth. When watery diarrhoea exists, tinged 
with healthy secretions, he has arrested it often at 
once by opium; and in nineteen cases out of twenty, 
convalescence has followed. But if the disease has 
advanced, he then gave repeated doses of calomel : 
moderated the discharges by opium, and softened the 
pulse by bleeding, if , necessary. If the disease pro- 
ceeds to vomiting, purging, and cramp, Mr. Fyfe pre- 
scribes a mustard emetic, followed by copious 
draughts of warm w 7 ater, friction, and the proper reg- 
ulation of heat. If the pulse is firm, blood is taken 
to the extent the pulse can bear. Calomel and opium 
are then used, and diluents allowed. In collapse, 
Mr. Fyfe objects to large opiates, and also to general 



224 TREATMENT OF 

bleeding ; but, in general, he gives relief by throwing 
into the intestines three pounds of very hot water, six 
ounces of brandy, and occasionally two drachms of 
laudanum. It will be frequently necessary to with- 
draw these injections by a tube — they come off cold 
— and to repeat them either with hot water alone, or 
with laudanum, if the irritability of the stomach con- 
tinues. In this stage Mr. Fyfe uses brandy liberally. 
He treats the reactive fever in the same way Mr. 
Frost does, as stated below, and I have already al- 
luded to some of his ingenious adaptations in my re- 
port. Mr. Fyfe thinks the period of the incubation 
of the morbific germ of cholera seems to vary from 
four hours to eight days. Mr. Fyfe is also of opinion 
that the effluvia, from the excretions of an individual 
having diarrhoea cholerica, may communicate to an- 
other predisposed the most developed form of the 
disease. 

Mr. Frost, of Newcastle, treated 500 cases of 
cholera, and is a person of high qualifications, a calm 
thinker, and an excellent practioner. I think the 
profession will be glad to hear his opinion and prac- 
tice in the disease, which 1 will give as accurately as 
1 can recollect a conversation held with that gentle- 
man at Newburn. He said that he conceived it a 
malignant congestive fever, — and if English physi- 
cians had seen this disease without reading Barry, 
Bell, Orton, and Lefevre, they would have treated it 
on scientific principles, and according to the rules of 
British art. They would have given no astringents. 
The catch-word of ' stop the diarrhoea' would never 
have existed. He stopped it, but in a far different 
method, viz., by calomel, castor oil, and very minute 
doses of opium ; say five grains calomel, one opium, 






THE CHOLERA. 225 

and two antimonial powder to begin with, several 
times repeated. If there is headach, and giddiness, 
and the pulse is of sufficient tone at the commence- 
ment, — if the pulse is from eighty to a hundred, bleed 
moderately. But the bleeding must be cautious ; for 
in this, as in all cases of intestinal irritation, bleedi 
cannot be largely practised with safety. If the stom- 
ach is much loaded, or there is nausea, give a draught 
of warm water to excite vomiting. If that does not ef- 
fect it, you may give salt and water, or ipecacuanha, 
or a, dose of castor oil, which mayTSe succeeded by a 
diaphoretic. This will open the skin. Next day 
calomel and castor oil again. If the castor oil will 
not stay on the stomach, the best substitute is magne- 
sia and rhubarb. If "the patient gets colder, then fill 
the large intestines with warm water from the forcing 
pump 5 and if you have any idea that the bowels are* 
not discharged, then put salt in the water. After 
this invariable stage of diarrhoea comes that of col- 
lapse. In every case where correct information 
could be obtained, diarrhoea hajf^eceded it- He 
gives warm water to induce vomiting"; injections of 
hot water ; the careful regulation of heat ; twenty 
drops of laudanum to allay irritation ; -two grains of 
calomel, and one-sixth of a grain of opium, evey three 
hours, for three times, and then castor oil In one 
case, for instance, under this treatment, the pulse rose 
to eighty, and the patient became warm. Eight 
ounces of blood were taken from the arm. He passed 
no urine for 48 hours. Mr. Frost went on with the 
calomel, and next day the urine returned, and he re- 
covered after a mild consecutive fever. He has never 
practised stimulation. The consecutive fever of chil- 
dren is almost always attended with the same symp- 



226 TREATMENT OF 

toms as hydrocephalus acutus. The hydrargyrus cum 
creta is the best remedy for them. He has seldom 
been able to induce ptyalism. Worms are very fre- 
quently vomited. They are always dead. The in- 
jesta of cholera seem poisonous to them. At New- 
burn, a village where Mr. Frost conducted a great 
part of the practice, two hundred and seventy-three 
cases of the disease occurred up till the day en which 
1 visited Newburn with Mr. Frost. Fifty of these 
cases were fatal. The whole inhabitants of the village 
were five hundred and fifty, one hundred and forty- 
one families, and one hundred and thirty-four houses. 
This is truly appalling. In general, even w 7 hen the 
cold stage is incomplete, consecutive fever sets in — 
there is much giddiness, pain ofthe head, and stupor. 
He has always treated this stage with laxatives. 
Mustard sinapisms applied to the neck, relieve the 
head ; to the epigastrium, the stomach. They have 
often been costive, but it has not been difficult to 
manage the bowels. Leeching to the head was fre- 
quently resorted to. Now, I ask the reader to com- 
pare the success of this treatment with that in the vil- 
lage of Hartly, where brandy and opium were used, 
and where, out of thirty four cases, thirty-two died. 

1 beg now to give the experience in this disease of 
an excellent friend, Mr. D. M'Allum. His acute- 
ness and talent are only equalled by the excellence 
of his heart and the soundness of his principles. 

Dear Sir, — Imperfect as naturally must be, from 
my limited opportunities, my capability of replying to 
your queries respecting cholera ; yet so far as my in- 
formation can contribute, in the slightest degree, to- 
wards the furtherance of your laudable object, 1 am 
happy to afford it. 



1 



THE CHOLERA. 22t 

In looking over the list of queries pioposed, 1 do 
not see that my individual experience can afford any 
information worth recording, but upon the last, viz., 
the treatment found most successful. In reference to 
treatment, I would divide this disease into three 
stages. 1 st, That of excitement, or irritation, wherein 
the patient throws or purges freely, generally accom- 
panied by severe spasmodic action of the muscles of 
the legs and bowels : the pulse distinctly perceptible, 
quick, sharp, and, in some subjects, full. This stage 
does not last beyond a few hours, passing on to, 2dly, 
The stage of collapse ; wherein the pulse becomes 
imperceptible, the extremities cold, the breathing 
more laborious, the countenance more sunk, espe- 
cially the eye, which assumes a leaden hue ; and, 
3dly, The stage of reaction. He who is happy enough 
to be called in during the first stage, will not hesitate, 
if the patient have any vigor of constitution, to bleed 
freely, premising, or using simultaneously, a gentle 
emetic of ipecacuanha, or salt and water, following 
this by an anodyne injection. I then administer a 
pill of two grains of calomel, and one-sixth of a grain 
of opium, every half hour, with chalk mixture, or sa- 
line julap, in a state of effervescence for a few hours, 
until we have dejections evidently combined with 
bile. To assist this operation, and especially if the 
vomiting be still severe, I administer warm emollient 
injections, and afterwards treat as in ordinary con- 
tinued fever In this stage of collapse, or approach- 
ing to it, I give a tea-spoonfui of mustard in a little 
warm water, every five minutes, till 1 produce vomit- 
ing; at the same moment I order enemata of very 
warm w 7 ater and soap, without reference to quantity, 
^endeavoring to throw up as much as ever I can. 



228 TREATMENT OF 

These means 1 find more successful in restoring heat 
than any external means ; but which I do not, never- 
theless, neglect, ordering hot applications to the feet, 
hands, and arm-pits, and that the patient be well 
rubbed with a stimulating liniment of spirits of tur- 
pentine, tincture of capsicum, mixed with camphorat- 
ed oil ; I then apply the hot air, both which I con- 
tinue at a temperature about 84, for two hours or more. 
In the mean time, as soon as the emetic has operated, 
I give six grains calomel, one-fourth of a grain of 
opium, every quarter of an hour, with two table - 
spoonfuls of a mixture containing compound spirit of 
ammonia three drachms, spirits of mindererus three 
drachms, mixed with hot coffee, giving warm liquids 
very freely and frequently. In this stage I have tried 
bleeding repeatedly, but without benefit ; indeed, it 
seemed to me to precipitate the fate of the patient. 
The enemata ought to be repeated frequently until 
reaction takes place. The third stage, viz., of reac- 
tion, requires no difference of treatment from that of 
our usual typhus mitior, excepting that bleeding 
should be had recourse to with very great caution, as 
I believe, by its too free use in improper cases, the 
stage of collapse has returned, and the patient sunk. 
There is generally a tendency to congestion, either 
of the brain or liver, which requires the application of 
leeches and blisters. The mortality in my own prac- 
tice was during the first three w r eeks — -exactly two to 
one recovered ; but since January commenced T have 
had seven cases, most of them applying early ; six 
of them are convalescing, and one dead. In Wall- 
send township, amid a population of 3000, there have 
hitherto occurred 15 cases and 4 deaths. 

In the above observations I have merely referred 



THE CHOLERA. 229 

to my own individual practice, and its results. Al- 
though T have had three patients in one house, I have 
met with no fact that could confirm the doctrine of 
contagion. 

Yours, respectfully, 

D. M'ALLUM, 
Blackett Square, Saturday, Jan. 14th, 1832. 



£0 



230 TREATMENT OF 

TREATMENT OF THE CHOLERA IN CANADA AND 
THE UNITED STATES. 

The first appearance on this continent of the epi- 
demic cholera, was in Canada, at Quebec and Mon- 
treal. 

At these places, it was noticed early in June, 1332. 
The first case published as epidemic cholera, occur- 
red at Quebec the 8th of June, and in a day or two 
after, several cases occurred at Montreal, and in the« 
course of a very short time, it raged in both places 
with a violence unknown in Europe, and unprece- 
dented in Asia. 

It ought, however, to be remarked, that according 
to the testimony of many of the physicians in Cana- 
da, a similar disease was noticed there early in the 
spring, and before any arrival of vessels from Europe. 
So malignant were these cases that occurred early in 
the spring at Montreal, that some of the medical men 
believed them to be cases of real Asiatic cholera, and 
expected to see that disease prevail, but it disappear- 
ed in a few days. When it did appear as an epi- 
demic, it came unexpectedly, and so sudden and vio- 
lent was the attack, and so numerous were its vic- 
tims, and so wretchedly circumstanced were the em- 
igrants from Ireland, among whom it most prevailed, 
that at first, but little was done, and but little could 
be done, as respects the administration of remedies. 
Hundreds died without any medical aid whatever. 
After awhile, better accommodations were obtained 
for the sick, and when the disease attacked the native 
inhabitants of the place, a more systematic course of 
treatment was adopted, and according to the state 



THE CHOLERA. 231 

mentsofthe physicians of Montreal, with very great 
success. 

A few of the medical men of Montreal have pub- 
lished brief statements of the practice they adopted in 
.the cholera, and which they found on trial, and on 
comparison with other methods of treatment, to be 
most successful. Their plans of treatment, I shall give 
in their own words. 

Dr. Caldwell, an eminent physician of Montreal, 
thus writes respecting the cholera, to Dr. Mc 
Naughton, of Albany : — 

" Montreal, June 24, 1832, 
Dear Sir,— 

i am just recovering from an attack of spasmodic 
cholera, and am still so weak as to be unable to enter 
into a minute detail ; but so far as my strength will 
permit, will answer the queries you have put. 

And with regard to the first, have to remark, that 
although it first appeared amongst the emigrants, the 
inhabitants have since suffered in much greater 
ratio. 

2d. In the first instance, it was principally confi- 
ned to the lower orders, but for the last ten days it 
has seized, indiscriminately, all classes. 

3d. If you are acquainted with the localities of 
Montreal, you will recollect a small creek or rivulet 
that runs immediately in the rear of the town, and 
very nearly throughout its whole extent from east to 
west ; it has undoubtedly confined itself in a great 
measure to the line of that channel, and the small al- 
leys running up from it ; so much so, that I think I 
am perfectly correct in stating, that 90 cases out of 
the 100 have occurred on the contiguous banks or al- 
leys running from them. 



232 TREATMENT OF 

4th. Two-thirds of the medical men have been at- 
tacked, and I believe all have felt its influence more 
or less. There has been only one deaths but that is 
accounted for from their being enabled to seize the 
first moment of attack, and not to any immunity they 
otherwise enjoyed. 

5th. The duration of the disease has been from 
four to twenty-four hours; the most frequent termin- 
ation, however, from seven to twelve. Adult age has 
exhibited a much greater susceptibility to the disease 
than early life, and this may be accounted for from 
the apprehensions of the latter not being so easily ex- 
cited. Fear unquestionably predisposes most pow- 
erfully, and such is the effect of the epidemic influ- 
ence on the nervous system, that ail are more or less 
affected by it 

6th. We have not had it in our power to carry the 
post mortem examinations to any great extent ; in 
the first place f from the increasing demand for medi- 
cal assistance, night and day, and latterly from the 
great number of medical gentlemen being laid up. In 
the few cases that have been examined, great venous 
congestion has existed throughout the abdominal vis.- 
cera, more particularly the stomach, intestinal canal, 
and mesentery ; and in several instances where the 
disease has been protracted for 24 or 36 hours, spha- 
celus had taken place. I have not had an opportuni- 
ty of seeing the head opened- 

With regard to the treatment, you will see an arti- 
cle in the Gazette of last week, by Dr. Arnoldi, which 
strikes me as being the most rational. There is an- 
other by Dr. Stephenson, in the Courant of yesterday, 
but there is this objection to the means he suggests, 
that in genuine spasmodic cholera* the irritation of 



THE CHOLERA. 233 

the stomach is so great, that liquids of no kind will be 
retained for an instant. 

In my own practice, I confess to you, and 1 would 
strongly impress it on your mind, that I have derived 
more advantage from what may be called prelimina- 
ry treatment, than from that during the actual attack. 
Cholera is invariably preceded by symptoms of gas- 
tric derangement, such as constriction or obstruction 
of the prsecordia, or a sense of corrugation of the up- 
per orifice of the stomach, loss of appetite, white fur- 
red tongue, nausea, occasionally slight diarrhoea, thril- 
ling sensations of heat through the bowels and differ- 
ent parts of the body, These symptoms may continue 
from a few hours, to a day or two, according to the 
degree of predisposition and susceptibility of the indi- 
vidual, and also the degree of concentration that may 
exist in the atmospherical influence at the time. The 
moment these symptoms showed themselves, I direct- 
ed the patients instantly to send to me, and gave them 
fromgr. x to xv of hydrag. cum creta, according to 
the age and strength of the patient, and in two hours 
followed it by tart, potassse dr. ii. in a little warm vea! 
or chicken broth, and repeated it every second hour, 
until it operated freely. Nothing seemed to allay the 
gastric irritation so well as the soluble tartar. In 
many instances it seemed to act as a charm, and I 
do not know a single instance of any one who went 
through the influence of this treatment that was sub- 
sequently attacked with cholera. In some instances 
it was necessary probably to repeat it once or twice ; 
and where the tongue was much loaded, I added two 
or three grains of the submuriate to it. 

In the convalescent stage, if much disposition to 

spasmodic action remained, I have derived great ad- 

20* 



234 TREATMENT OF 

vantage from the cajuput oil, in doses of from 15 to 
25 drops, particularly in females, mixed with lauda- 
rium, magnesia, &c. according as circumstances in- 
dicated. > These hints will, 1 trust, enable you to 
meet the disease, should it unfortunately find its way 
to your city, with more confidence than 1 did at the 
outset. The epidemic has for the last two days com- 
pletely subsided, and has been succeeded by fever of 
a low synochus form. 

Believe me, dear sir, very truly yours, 

W. CALDWELL." 

Dr. Nelson, Member of the Medical Board and 
Commissioner of Health of Montreal, thus describes 
the treatment which he found most successful. 

Treatment. — First Symptom. The principal me- 
dium through which remedial means can be applied, 
is the stomach. We are therefore compelled to look 
to this organ first ; and as no remedy can be of ser- 
vice there unless it be retained, we must, before all 
other things, arrest the vomiting, if there be any, and 
suffer the stomach to become perfectly calm before 
any other medicine or substance be introduced, lest 
by so doing we arouse the evil just subdued. As re- 
lates to the stomach, there are two distinct stages in 
the disease, and on a just appreciation of these will 
the success of the practitioner depend. The first is 
the vomiting, the second is the stage of collapse, or 
sinking, when all vomiting shall have ceased. Now, 
as the only known means to stop vomiting in this dis- 
ease, and many others, is to paralyse the stomach, 
we must carefully bear in mind, while prescribing for 
the first, not to overdo the thing, lest when we re- 



THE CHOLERA. 235 

quire the energies of the stomach, in the second stage, 
we find them irrevocably lost in a collapse, which is 
joined to the common sinking of all parts of the 
body into death, (the sensorium excepted). Here 
resides the first and greatest secret in prescribing for 
a cholera patient ; and which, to the unobserving 
multitude, has occasioned so much apparent discrep- 
ancy in the treatment of different practitioners. In 
the first stage, the most sedative treatment is essen- 
tial 5 while in the second, the very opposite, that of 
excitation. 

How to paralyse the stomach, and consequently to 
arrest the vomiting. Three very particular circum- 
stances are to be borne in mind, — 1st, the remedy, — 
2d, how to be administered, — 3d, comportment of the 
patient. After all that has been said, it will be found 
that every practitioner from the Ganges to the Vistu- 
la, has been forced, whatever his preconceived no- 
tions may have been, to look to opium as his anchor 
of hope ; but it is to be regretted that a remedy so 
good, so perfect from mal-administration, should have 
been turned into a two* edged sword, at once curing 
and killing the patient. Opium has been given in ev- 
ery form, and in various combinations ; this last is 
the error, as the pathological state of the stomach will 
readily account for. There is such an inordinate 
sensitiveness at this stage, in this organ, that it will 
not suffer scarcely the smallest bulk of any substance ; 
how T injudicious then to augment the size of the rem- 
edy, by the addition of medicated waters, in them- 
selves useless ; and how much more unscientific to 
add a stimulant to your sedative, when the latter ef- 
fect is the object of the prescription. Let the reme- 
dy then be a sedative, and not a stimulant ; give opi- 



236 TREATMENT OF 

um, and let the dose be concentrated to the smallest 
size ; give one grain of solid opium, it must be swal- 
lowed dry : if that be rejected, give a second, and so 
on to a third ; it will rarely happen if the 3d circum- 
stance be observed, that a fourth dose shall be requi- 
red. One grain of opium is so small a body, that 
the stomach can easily bear it, while the same reme- 
dy, given in form of a draught, from size alone shall 
be injurious. 

3d. The patient is naturally restless, and any mo- 
tion of the body is more or less communicated to the 
stomach, and it has been observed, times out of num- 
ber, that the mere turning round of the patient has so 
acted on the stomach as to set it again in operation. 
Motion of the body may so act on the abdominal sur- v 
face of the stomach, as to affect the internal with a 
sensation of foreign substance, and thus account for 
the effect. To sum up, for the vomiting stage, give 
one grain of opium, and give it dry ; give nothing else 
till vomiting shall have ceased for several hours, and 
keep the patient in the most quiescent state possible. 
During all this time, the patient suffers intolerable 
thirst ; this he must bear with. Drink will be re- 
turned almost before it reach the stomach, and can- 
not relieve the symptom for which it was given, 
whilst it gives the patient one more dreadful convul- 
sion, each of which hurries him to his end with a ten- 
fold degree of velocity. Bear in mind, that one grain 
of opium is as effectual in arresting the irritability of 
the stomach, as ten grains, while the latter dose would 
not only do the same, but also paralyse the stom- 
ach beyond the term of resuscitation. The abuse of 
opium too frequently occurred at Montreal." 



THE CHOLERA. 287; 

Second Stage. — All is now quiet, and now is the 
time to give stimuli. Small doses of warm brandy^ 
warm punch, aether or ammonia \ but be careful to 
choose such as are palatable to the patient. 

The second symptom to be analyzed is the asphyx- 
iated state of the extreme parts of the body, and also 
the apoplectic state, as the French call it, of the more 
central viscera. This asphyxia is known, as the term 
implies, by the cessation of circulation, and blueness 
and coldness of the surface. Fortunately it is not 
difficult to appreciate the indication, though one may 
not be so sure of its success. The cause is perhaps 
internal:, but unknown : but the wet state of the sur- 
face, by evaporation, contributes more rapidly to cool 
down to the term of death. While you are calming 
the stomach, take also in charge this last symptom, 
and treat it thus : Dry the surface of the body by nap- 
kins, and then still further dry it, by rubbing the pa- 
tient over with powdered chalk ; and by previously 
heating the chalk, you will render it doubly useful. 
For this purpose chalk was recommended by a gen- 
tleman of Quebec. If chalk cannot be had, the best 
article as a substitute is flour ; but be careful in heat- 
ing it not to suffer it to grow brown., lest by the 
change of color its intransmissibility of caloric be 
diminished. By fomentations and moist heat, we are 
undoing with one hand what we are attempting with 
the other. Moist heat is in the very teeth of natural 
philosophy, and he who uses it, publishes his deficien- 
cy in the collateral branches of his profession. 

3d. The third symptom is spasm. In attending to 
the two first as recommended, we do all that is re- 
quisite for the third. Opium, as an antispasmodic, 
and frictions. 



238 TREATMENT OF 

AH other remaining symptoms are unworthy of no- 
tice in this hasty sketch. They are mere concomit- 
ants, or sequels of the former, and require to be pre- 
scribed pro re nata. 

P. S. I am induced to add the present postscript, 
seeing that some persons have not fully comprehended 
xny meaning when I referred to pro re nata prescrip- 
tions. 

I have purposely avoided speaking of the mustard 
emetic, a remedy in this disease so nauseously absurd. 
The idea of bleeding in cholera has its origin based 
on an hydraulic theory, totally inadmissible in this 
disease ; and we have seen its warmest supporters 
abandon the child of their creation or adoption ; it 
has been tried here a few times, and not found to an- 
swer. 

Calomel, a remedy without which an English phy- 
sician could not live, has, in its place, a good effect, 
but its place is more rarely found than the Briton im- 
agines ; in whose practice it forms as invariable, as 
constant, and often as annoying, an adjunct, as pins 
do in a lady's dress ; in a lady's dress, pins must form 
the tie ; in a gentleman's, buttons. The British will 
have pins, the Continental European, buttons ; they 
are both good ; on occasions, one is preferable to the 
other." 

The treatment adopted by Dr. Arnoldi and son, 
and which has received the approbation of most of 
the physicians in Montreal, is as follows : — 
Statement of the Doctors Arnoldi. 

Having now so many data to go by, of the efficacy 
of our practice, in this most direful disease, (cholera) 
and knowing that the members of the medical pro- 






THE CHOLERA. 239 



fession are not agreed upon a decided or uniform mode 
of treatment, we take the liberty of announcing to 
the public, through the medium of your types, that 
our practice consists in ordering a total abstinence 
from all liquids, (and solids of coiirse) from the mo- 
ment the person feels himself under the influence of 
any symptom threatening cholera, by which suffi- 
cient time is gained to obtain medical advice. Our 
prescription is simply one pill, containing one grain of 
fresh opium and seven of calomel, which is to be 
swallowed dry, without the aid of any liquid, if pos- 
sible. The use of all beverages, we then insist upon be- 
ing most strictly abstained from, until every symptom 
has subsided, and something like hunger has returned. 
In few instances have we had occasion to repeat the 
pill, unless the patient's stomach did not retain the 
first (and which was uniformly occasioned by the 
fluids present in the stomach at the time,) and in the 
course of a few hours, we generally followed up by 
an ounce of Epsom salts, dissolved in half a pint of 
water, and a wine-glass full taken every hour. The 
subsequent treatment varied according to the pecu- 
liarities of the case, and could be regulated by the 
judgment of any practitioner/keeping strictly in mind 
the yet remaining irritability of the stomach as to flu- 
ids. Our exertions have been too frequently paralys- 
ed by the absurd practice of taking laudanum or opi- 
um pills previous to sending for advice. The pecu- 
liarity of our plan, and to which we ascribe our whole 
success, consists in obtaining the arrest of the urgent 
symptoms by the least possible dose of opium, and 
absolutely doing nothing. The plan is too simple to 
be generally credited, but hundreds have experienc- 



S40 TREATMENT OF 

ed the efficacy of it ; and we would strongly recom- 
mend, at least, the first trial to every medical man. 

The plan of sweating the patient we have had too 
frequent occasions to lament and discountenance, but 
we nevertheless do every thing in our power to re- 
store heat to the extremities, by the -application of 
bottles of boiling water, hot bricks, &c. &c. in the 
usual manner ; frictions with hot dry flannels, (some- 
times in desperate cases, sprinkled over with mus- 
tard.) In short, dry heat in any manner whatever, 
and this we find most speedily successful when the 
body itself is but slightly covered. The spasms are 
best relieved by keeping the patient in one posture, 
the slightest motion being apt to induce them. We 
candidly acknowledge that where the blue stage, co- 
pious sweats, and cold extremeties have set in, before 
medical aid is called for, we consider the case hope- 
less ; but even under the most appalling circumstan- 
ces, the perseverance in the above injunctions has oc- 
casionally been attended with favorable results. 

Our injunctions therefore, are, that no medicine be 
kept in the possession of any individual for the pur- 
pose of being taken, either as a precautionary step, or 
before calling in medical aid. 

That no person feeling indisposed, take medicine 
from any but a professional man. 

That a correct detail of all the symptoms be given 
by any intelligent messenger to the doctor. 

That no person should rely on the efficacy of any 
of those drugs that are vended as specifics; everyone 
of our fatal cases hasbeen preceded by the exhibition 
of these drugs, or the opium pills so generally sup- 
posed to be the first step towards the cure, the folly of 
which cannot be too strongly reprobated. 



tTHE CHOLERA. 241 

That when a person has once put himself under the 
are of a medical man, he should continue to follow 
his prescriptions solely. The interference of friends 
has been attended by the most fatal consequences, 
and that of professional men not less so, exclusively of 
the indelicacy and want of consideration that should 
subsist between the members of the profession ; as it 
is but right that he who has the responsibility, should 
at least have the management. 
D. ARNOLDI, 
FRANCIS C. T. ARNOLDI, M. D." 

It is, however, important, though humiliating, to 
add, that neither the above methods of treatment, nor 
any other, adopted at Montreal, appeared to be of any 
service in innumerable instances. I have been as- 
sured by intelligent eye witnesses who attended upon 
the practice of Dr. Arnoldi, that they saw it of no 
avail in very many cases. 

One medical gentleman who saw much of this 
practice at Montreal, writes me that a it failed in all 
the cases he saw in the stage of collapse." It was 
however as beneficial as any other course pursued, 
and in the less violent cases, proved highly service- 
able. 

When it was known that the cholera actually pre- 
vailed in Canada, it excited universal alarm through- 
out the United States. Many of the large towns sent 
deputations of medical men to Montreal, to witness 
the disease, and to obtain all the information in their 
power, from personal observation, respecting this new 
pestilence. All the large cities entered very actively 
upon sanitory measures, such as cleansing the streets, 
and the filthy parts of the town. In some places, 

21 



242 TREATMENT OF 

cholera hospitals were provided, and fitted up for the 
reception of the sick. Quarantine regulations were 
adopted and enforced, to prevent the disease being 
brought from Canada and from Europe. But not- 
withstanding all these precautions, the disease actual- 
ly appeared in New York, towards the last of June, 
1 82£, It appeared in different parts of the city at the 
same time, and no one has yet attempted to show that 
it was imported, or to point out the origin of the dis- 
eass at New York. 

The disease, however, found the Board of Health 
at New York unprepared to meet it at first with that 
care and attention which is requisite in order to give a 
fair trial to the efficacy of remedies. A sufficient num- 
ber of hospitals, with medical and other attendants, 
and apparatus necessary for the sick, had not been 
provided, and for a few days, no conclusions could 
be drawn respecting the influence of remedies upon 
the disease. In a short time, however, hospitals, &c. 
were provided, and more order prevailed, and great- 
er efforts were directed to the vigorous prosecution of 
measures calculated to cure those attacked by the 
disease. 

Almost every remedy which had been tried else- 
where, has been resorted to at New York, and yet it 
is a lamentable fact that they have all failed in severe 
cases. 

The most successful treatment as yet adopted at N. 
York has been pursued to the greatest extent at Green- 
wich hospital. It consists chiefly in the use of exter- 
nal means, such as the application of cayenne pep- 
per, mustard cataplasms, frictions, &c. &c. — giving 
but little, and in the stage of collapse no medicine by 
the mouth. 



THE CHOLERA, 243 

In this deplorable stage the patients were nibbed 
! with the following ointment : — 

R. Ung. Hyd. fort, ife.j. 
Pulv. camphor g viii. 
cayenne g iv. M. 

[ This ointment when diligently rubbed upon the 
: body and limbs, generally produced some reaction, 
and often produced slight salivation in six or eight 
hours. When it did so, the patients were considered 
safe. 
The consecutive symptoms were successfully met, 
L and treated like those of inflammatory fever, by lo- 
cal bleeding, blistering, &c. 

A few have been cured in New York by the in- 
jection of saline solutions into the veins. 

Dr. Rhinelander stated to the Board of Health of 
New York the case of Margaret Mehan, who was 
Li cured at the Crosby street hospital, by injecting into 
. the veins, twenty four ounces of a solution composed 
I of one drachm of carb. soda, and two drachms of 
a muriate of soda (common salt) dissolved in six pints 
of water. The operation was performed at 1 P. M. 
L July 21st. 

jj Several other cases of cholera have been cured in 

a similar manner, both in this country, and also in 

England, where the practice 1 believe originated. 

This practice is undoubtedly founded upon the 

. fact, said to have been discovered by analysis ; that 

the blood drawn from a patient affected with chole- 

- ra, has lost a portion of its watery and albuminous 

« parts, arid also most of its natural saline ingredients. 

According to Dr. Reid Clanny, of Sunderland, in 



756 


644 


121 


31 


59 


253 


32 


66 


18 


6 



244 TREATMENT OF 

a communication which he made to the editor of the 
London Lancet, the blood drawn from a patient who 
had been five hours affected with cholera, had no 
taste nor any particular smell. It contained no gases 
of any description, and was as black as tar. For 
comparison Dr. C. gives the analysis of the blood of 
a healthy person. 

This last contained one cubic inch of carbonic 
acid in the sixteen ounces. 

Health]/ Blood. Cholera Patient. 
Water, 

Albumen coagulated, 
Coloring matter, 
Free carbon, 
Fibrine pressed and dried, 
Muriates of soda and"^ 

potassa, carbonate I -. 

of soda and animal [ 

extraction, J 

1000 1000 

Dr. O'Shaugnessy, instituted experiments on the 
blood of cholera patients and obtained the following 
results. 

" 1. The blood drawn in the worst cases of chole- 
ra is unchanged in its anatomical or globular struc- 
ture .2. It has lost a large portion of its water : 1000 
parts of cholera serum having but the average of 850 
parts of water. 3. It has lost also a great proportion 
of its natural saline ingredients. 4. Of the free al- 
kali contained in healthy serum, not a particle is pre- 
sent in some cases, and barely a trace in others. 5. 
Urea exists in the cases where suppression of urine 
has been a marked symptom. 6, All the salts defi- 
cient in the blood, especially the alkali or carbonate 



. 



THE CHOLERA. 245 



f soda, are present in large quantities in the peculiar 
white dejected matters." 

These facts are exceedingly curious, and if con- 
firmed by other cases and experiments, may lead to 
new views of the pathology of the disease, if not to 
new and more effectual methods of treating it. 

The following communications from Dr* Lewins, 
to the Secretary of the Central Board of Health, Eug- 
3and, will serve to show the effect of injecting sal«ne 
solutions into the veins, and the method of perform- 
ing the operation. 

" Sir,— I conceive it to be my duty to let you know, 
for the information of the Central Board of Health, 
that the great desideratum of restoring the natural 
current in the veins and arteries, of improving the 
color of the blood, and recovering the functions of the 
lungs in cholera asphyxia, may be accomplished by 
injecting a weak saline solution into the veins of the 
patient. To Dr. Thomas Latta, of this place, is due 
the merit of first having recourse to this practice. He 
has tried it in six cases, three of which I have seen 
and assisted to treat. The most wonderful and sat- 
isfactory effect is the immediate consequence of the 
injection. To produce the effect referred to, a large 
quantity must be injected — from five to ten pounds in 
an adult — and repeated at longer or shorter intervals, 
as the state of the pulse, and other symptoms, may 
indicate. Whenever the pulse fails, more fluid ought 
to be thrown in, to produce an effect upon it, without 
regard to quantity. In one of the cases I have refer- 
red to, 120 ounces were injected at once, and repeat- 
ed to the amount of 330 ounces, in twelve hours. In 
another, 376 ounces were thrown into the veins, be- 
tween Sunday, at 11 oVlock, A. M., and this day 
21* 



246 TREATMENT OF 

(Tuesday) at 4 P. M., that is, in the course of 53 
hours, upwards of 31 pounds. 

The solution that was used consisted of two 
drachms of muriate, and two scruples of carbonate 
of soda, to sixty ounces of water. It was at the tem- 
perature of 108 or 110 degrees. 

The apparatus employed in injecting was merely 
one of Reid's common syringes, (the fluid being put in- 
to a vessel rather deep and narrow), with a small pipe 
fitted, that it might easily be introduced into an incis^ 
ion in the veins of the usual size that is made in 
bleeding. It may, however, be well to keep in mind* 
that, in the event of the operation being frequently re^ 
peated, it may be advisable to inject by different 
veins. 

I forbear at present to enter further into the par* 
ticulars ; nor have we had sufficient experience to 
speak decisively on the subject. I may, however, 
mention that the idea of having recourse to this reme- 
dy in cholera, occurred to Dr. Latta, from being con- 
vinced (which I am also) that the evacuations up- 
ward and downwards, are, in reality, the serum of the 
blood ; that it is the duty of the physician to replace 
it, as speedily as possible, by injecting a fluid, as sim- 
ilar to the serum as can be formed artificially, direct^ 
ly into the veins, which has been done here with won- 
derful, and, so far as we can yet judge, excellent ef- 
fect. An immediate return of the pulse, an improve- 
ment in the respiration and in the voice, an evolution 
of heat, an improvement in the appearance of the pa- 
tient, with a feeling of comfort, are the immediate ef- 
fects. The quantity necessary to be injected, will 
probably be found to depend upon the quantity of se- 
rum lost— the object of the practice being to place the 






THE CHOLERA, 247 



patient in nearly his ordinary state, as to the quanti- 
ty of blood circulating in the vessels. 
I have, &c. 
(Signed) ROBERT LEVVINS, M. D, 

To W. Maclean., Esq. 

Secretary to the Central Board of Health. 

Sir, — I did myself the honor to address a letter to 
you lately, on the effects of injecting a saline solution 
into the veins of a patient laboring under cholera. 
We have not frequent opportunities of trying this, 
which I denominate admirable remedy, as the dis- 
ease is decidedly less frequent here ; but I have seen 
it employed in two other cases, in the course of the 
last two days, with the same excellent effect. Sixty 
ounces are generally thrown in at once, and repeat- 
ed at the end of three or four hours. In a case to* 
day, where I saw fifty-eight ounces injected, (being 
the third time of performing the operation), the pa- 
tient's pulse, at the commencement was 1 80, very 
small, and very feeble. She was excessively rest- 
less, with a feeling of great weakness and tormenting 
thirst. Before twelve ounces were injected, the pulse 
began to "improve ; it became fuller and slower, and 
it continued to improve, until, after 58 ounces had 
been injected, it was down to 1 10. Before I left the 
patient, (a woman) her condition was altogether ama- 
zingly amended. There was a fine glow, and a 
slight perspiration on her face ; the veins on the back 
of her head were well filled ; the restlessness was re- 
moved, the feeling of excessive weakness gone, and 
the thirst ceased. The pulse was under 100, free, 
full and soft. Verily, Sir, this is an astonishing meth- 



248 TREATMENT OF 

od of medication, and I predict will lead to wonderful 
changes and improvements in the practice of medi- 
cine. I have addressed you upon the subject, as the 
organ, from your high official station, of dissemina- 
ting a knowledge of the extraordinary facts referred 
to. It will, of course, give me great pleasure to enter 
further into particulars upon any particular point on 
which you may require information, in reference to 
the cases which have come under my observation. 
I have, &c. 
(Signed) ROBERT LEWINS, M. D. 
To W. Maclean, Esq., 

Secretary to the Central Board of Health. 

In the hands of a man of ordinary dexterity, the 
common injecting apparatus alluded to in my last, 
will be found to answer the purpose perfectly well ; 
but if the practice I recommend is, as I hope it will 
be, generally adopted, it will, I conceive, be expedi- 
ent to advise that a regular and perfect transfusion ap- 
paratus be used ; at all events, to warn those who in- 
ject to beware of allowing air to get into the vein, The 
tubesj of course, must be filled with fluid, as well as 
the pipe in the vein, before commencing, and conside- 
rably more fluid than it is intended to use ought to 
be in the vessel from which it is pumped. 

R. L." 

I understand that a work upon the efficacy of in- 
jecting the veins, is now publishing at New- York, and 
as this practice has been much resorted to in that 
place, its full value as a remedy in cholera,'will soon 
be known. 

I ought also to state, that the exclusive camphor 



THE CHOLERA. 249 

treatment has been employed at the Park Hos- 
pital, at New- York, and I am informed, with 
success. The practice consists of giving small doses 
of spirits of camphor very frequently, and withhold- 
ing all other medicines. Dr. William Channing, of 
JNew-York, is a warm advocate for this practice. 
He believes camphor in small doses to be a specific 
for the cholera. He states that of 250 patients at- 
tacked by cholera, and many of them violently, and 
who have been treated exclusively by camphor, on- 
ly five have died. He recommends from one to three 
drops of unmixed spirits of camphor to be given in a 
little water every hour or two, and every other medi- 
cine, especially opium, to be withheld. 



250 LECTURES ON 



TWO LECTURES 

ON THE 

CHOLERA MORBUS, 

DELIVERED AT THE B1ILITARY HOSPITAL OF 
VAL-DE- GRACE, BY 

J. F. V. BROUSSAIS, M. D. 

Officer of the Royal Order of the Legion of Honor, 
Physician in Chief and First Professor of the 
Military Hospital of Instruction of Paris, fyc. 

Delivered during the prevalence of the disease in 
Paris, April 18, 1832. 

Prof. Broussais had announced to his class that his 
lecture for this day, would be upon the epidemic 
which had caused of late, great ravages, and still 
greater terror in the capital of France. The. amphi- 
theatre was filled at an early hour, by a crowd of 
auditors more eager than usual to hear the Profes- 
sor. 

At 8 o'clock, Broussais appeared, and delivered 
the following lecture, to an attentive and silent au- 
dience. 

" Gentlemen, — Before commencing, I desire to 
know if you wish me to deliver ail I have to say upon 
the epidemic, in one lecture, or in two." 
(All the class, in two— in two lectures.) 
" Very well, gentlemen, I will give you two lec- 
tures. In the lecture of to-day, I will speak of the 



THE CHOLERA. 251 

disease, and in that of to-morrow, 1 will dwell upon 
the treatment." 

Gentlemen, 

The disease, the nature of which we are now to 
investigate, is called the Cholera Morbus,* The 
name comes from another malady, so called, be- 
cause those affected with it vomit a great deal of bile, 
The denomination was given to it in the times when 
the humoral doctrines were in vogue ; at which peri- 
od, diseases were attributed to humors, when their 
evacuation was most apparent, or seemed to explain 
the nature of the disease. Thus, in the sporadic 
cholera, there is always a large secretion of bile ; and 
thence the name of cholera morbus^ from the Greek 
word cholos, bile, and the Latin word morbus, disease ; 
so that the etymological signification of the word is, 
disease of the bile. This name has been applied on 
account of the number of symptoms belonging to the 
epidemic which has long been known in the equato- 
rial regions, and which now rages within our walls. 

This epidemic has doubtless prevailed at several 
different epochs, and probably is the same as the 
frightful pestilence which made its appearance in the 
year 1348, and carried off nearly a third part of the 
existing population ; and it has in effect a very great 
affinity to what is told us of the black fever or black 
plague. But whatever may have been its nature, it 
w r as forgotten in our region. We read, from time to 
time, numerous articles in the papers, upon the rava- 
ges which the cholera morbus had made at Calcutta 
and other cities of India or the Levant, but it was still 



* These two lectures have been translated and published by John 
S. Bartlett, M. P., Albion Office, Cedar street, New York. 



252 LECTURES ON 

nothing more than a matter of curiosity. The 
English, who have considerable establishments in the 
East Indies, had never introduced the disease into 
their own countiy, and the small number of French 
who have visited those places, never spread its conta- 
gion at home. Whether this was owing to the cir- 
cumstance that the communications between these 
countries have always been by sea, to the kind of food 
taken during the voyage, or to the fresh winds which 
blow over the water, and thus destroy the causes of 
the malady, whatever they may be, 1 cannot say ; 
but certain it is, that the disease had never left the 
place of its origin. 

The Russians first introduced the cholera into Eu- 
rope, by means of their communications over land 
with Persia, India, and countries of the east, where 
the English have settlements, the disease having fol- 
lowed their armies. They brought it to Warsaw, and 
thence it has spread over various parts of the con- 
tinent. It has appeared in different districts of Ger- 
many, in the provinces bordering upon Turkey, in 
Hungaria, and Austria ; in short, it has been propa- 
gated to a great extent in the north and east of Eu- 
rope, and has manifested the same violence as in the 
tropics. This circumstance constitutes an essential 
difference between the cholera and the yellow fever, 
which never appears, or at least, never prevails to 
much extent in cold climates. In fact, the yellow 
fever is supported by heat, and by emanations from 
low and marshy grounds; but the cholera needs no 
such aliment ; it respects neither country nor season. 

The cholera morbus, arriving in our latitude, mani- 
fested itself first in England, and hence it appears 
that an intervening sea cannot arrest its progress. 



THE CHOLERA, 253 

though the distance, it is true, from the continent to 
England is very trifling in comparison with that to 
India. I only allude to the circumstances as impor- 
tant considerations in our researches, and not as tend- 
ing to establish, with any certainty, the manner by 
which the disease may be propagated. 

The malady was preceded in many of the cities in 
the north and east of Germany by a sort of convul- 
sive catarrh, which was called grip ; the year follow- 
ing this scourge appeared in all the places which had 
been previously visited with the grip, and persons 
who had made accurate observations and calcula- 
tions of its progress, predicted from the appearance 
of the grip here last year, that the cholera would 
follow it the next. In this hospital we certainly dis- 
covered the forerunners of this event, (not the grip, 
for I acknowledge that during the last year we had 
very few cases of the convulsive catarrh, and I hard- 
ly believed in the existence of the grip, so rare were 
its instances,) but we observed some weeks before 
the appearance of the cholera, a great susceptibility 
in the digestive organs, so that we were obliged to 
reduce the aliment of many of our convalescent pa- 
tients, and to renounce some means of internal revul- 
sions which w r e were employing in cases of catarrh and 
and peripneumony. Some experiments which we 
made of the use of tartar emetic in cases of inflam- 
mation of the lungs, were attended with remarkable 
success in the winter \ but we observed, all at once, 
that it had become impossible to introduce this medi- 
cine into the digestive canal of certain of our patients 
without producing the most disagreeable effects. 
Many threw up the tartar emetic and experienced 

violent convulsions of the stomach. In two cases, 

22 



254 LECTURES ON 

which I particularly remember, the pulse was scarce- 
ly perceptible for the space of sixteen days ; the 
patients were in the same situation as those who are 
now affected with the cholera, except that the pulse 
was not quite extinct ; they were in a state of ex- 
treme stupor ; the eyes red; the extremities cold, and 
the pulse at times imperceptible; their evacuations 
and vomitings frequent. This malady, treated upon 
the system of antiphlogistics, yielded to the medicine, 
but the patients were for a long time cold ; but I 
confess that this observation was not of sufficient im- 
portance to decide me upon following the same sys- 
tem in cases of the cholera when it appeared with 
such violence in this hospital at first. Some time af- 
ter a patient was brought, whose pulse had nearly 
ceased ; he was bled profusely, and we then disco- 
vered that he had an inflammation of the lungs, 
which nothing would have led us to suspect when his 
pulse was nearly extinct. Here, then, are symptoms 
which seem to indicate an increased irritability of the 
organs of digestion. Under the influence of what 
causes, then, has this increased irritability taken 
place ? A question by no means easy to determine. 
Let us proceed to the development of the actual epi- 
demic. It broke out all at once among the poorest 
and most miserable classes of the people in Paris, and 
those first attacked were carried to the Hotel Dieu ; 
three days after we had cases of it attheValde 
Grace ; it had also made its appearance at the Gros 
Caillou, nearly at the same time as at the Hotel Dieu. 
The precise epoch of its appearance, was, I believe, 
the 26th of March : we had no case of it at this hos- 
pital, however, till the 29th. 

Let us now recall what has been said of the man- 



THE CHOLERA. 255 

ner in which it is propagated. The disease had 
scarcely any appearance of being contagious, since 
the persons who were first attacked, certainly had?no 
communication with those who might have been in 
England ; at least, this was the most probable sup- 
position. However this may be, I will proceed to lay 
before you whatever facts I am in possession of re- 
garding the manner of propagation. Doubtless the 
disease showed itself first in persons who had never 
been in contact with those affected by it It is too 
strongly marked to have been brought in any vessel 
coming to France, for this would have immediately 
been discovered. Some person attacked with the 
cholera, arriving at Calais, or some other sea-port, 
would have communicated it to those about him, 
Nothing of the kind, however, is known to have 
happened. But although those first seized did not 
appear to have taken the infection from any 
one else, it is a well established fact, that when the 
malady had once declared itself in a house, it almost 
always happened that a number of persons were at- 
tacked in the same house, and 1 know of no instance 
where it has been confined to a single individual un- 
der one roof ; I have no doubt there may be such in- 
stances, but 1 know many to the contrary ; and in 
general, upon being called to visit a patient seized 
with the cholera, I have noticed that several cases 
ensued the following two or three days. This fact 
gives rise to the suspicion that there is a species of 
infection by which the patient communicates the dis- 
ease to those who have charge of him. But, on the 
other hand, the inmates of the same house may be 
regarded as exposed to the same influences, and thus 
contracting the disease independently of all conta- 



256 LECTURES ON 

gion. This is possible 5 but still cases of the cholera 
are known to occur in different stories, and different 
families living in the same house, with various modes 
and habits of life ; so that it would seem that in these 
houses there is some peculiar cause which multiplies 
its ravages. 

We must, however, make a great allowance for 
the moral affections ; those persons who are struck 
with terror at the sight of choleric patients, are doubt- 
less very strongly predisposed to the disease. I will 
mention to you the example of a very distinguished 
person, an eminent foreigner, whose name, however, 
I am not at liberty to make public. This gentleman 
had traced upon the map the whole progress of the 
cholera ; he conversed with his physician several 
times a week upon the route it had already taken, 
and was continually occupied in calculating the time 
w T hen it would appear in such and such a place, and 
finally when it would reach France. The cholera 
having broken out here, " Behold,' 5 said he, "the dis- 
ease is now at Paris ; there is no doubt I shall feel its 
effects." He took pains to be informed every day 
of the number taken, and the number dead, but at 
first discovered no symptom of the disease in himself 
He at length however experienced the diarrhoea 
which usually precedes the cholera, and though it was 
carefully treated from the first, nothing could arrest its 
progress. This is a case under my own eyes, for I was 
called to the patient by his attending physician. I 
could mention several similar cases. I found one 
yesterday of the same nature. A patient whom I 
had cured of an extremely obstinate inflammation of 
the stomach and bowels, was in great fear of the cho- 
lera. He went to pay a visit to one of his friends. 



THE CHOLERA. 257 

who was attacked, but did not venture into the cham- 
ber, as he found the whole family in tears and deeply 
afflicted ; he had hardly entered the house when he 
was seized with the cholera ; and I think he will die 
this day. Thus it appears that the disease is propa- 
gated by the most extraordinary means. 

From some circumstances, it would appear that 
the disease is carried in the air ; but this supposition 
is contradicted by the fact, that the cholera, thus re- 
gularly distributed over the same plain, attacks one 
village while it spares another ; that it is not com- 
municated by the inhabitants who are continually 
passing from one to the other; and that the same per- 
sons who had ventured with impunity into the midst 
of the sick, were attacked when the scourge at length 
arrived to their own place of residence. There is 
something so extraordinary in the manner in which 
the malady advances, that it merits the attention of 
physicians. After all the facts I have cited, 1 am in 
doubt if 1 ought to admit the idea of infection asjit is 
generally understood. It is certainly impossible to 
allow that the disease is contagious, at least in the 
same way as the small pox or the itch •, for this epi- 
demic is not communicated by inoculation* Persons 
have inoculated themselves with the blood of choleric 
patients ; others have even swallowed it ; and others 
have impregnated their garments with it ; some have 
had the courage to sleep in the same bed with the 
sick; and, in short, every experiment of the kind 
has been made, and the disease has in no instance 
been thus contracted. These experiments were 
doubtless made by men of courage ; for, had timid 
persons been forcibly inoculated, 1 have no doubt that 

22* 



258 LECTURES ON 

they would have taken the disease. I am of opinion 
that courageous and devoted men could alone have 
made- these experiments with impunity ; a circum- 
stance well worthy of novice. The author of a re- 
cent work on the subject, speaks of a choleric atmos- 
phere which is confined to a city, a village, or to a 
single house even : but the existence of this atmos- 
phere cannot be demonstrated. It is certain, how- 
ever, that there exists a strong predisposition to chole- 
ra, and it is to this point that our researches must be 
directed at present. 

[Here the attention of the audience was re- 
doubled.'] 

It is proved by the reports of French physicians, 
who have visited other countries to study the nature 
of cholera, that every remarkable derangement of the 
gastric system may be followed by this malady when 
it prevails in the country. There are instances, how- 
ever, of persons being seized with it, who were in 
good health, and with no other previous symptoms 
than those of the disease itself; but these cases are 
very rare. The malady is generally first announced 
by a slight relax, unattended by any disagreeable 
symptoms : when this ordinary relax already exists, 
that produced by the cholera discovers itself in a 
manner not to be mistaken. Thus, the first predis- 
posing causes are diarrhoea and indigestion, and 
chronic irritations of the gastric system, which may 
have existed for a longer or shorter period : but, 
above all, a disposition to diarrhoea. Another pre- 
disposition to cholera is terror, one of the most pow- 
erful causes, undoubtedly. I have already mention- 
ed one of the numerous instances I have met with of 
this. 



THE CHOLERA. 259 

Predisposing Causes. 
Intoxication. — Men who were in good health, hav- 
ing been intoxicated, have been seized the day follow- 
ing with cholera, though they had experienced no pre- 
vious indigestion ; with the last exception, this case 
would be ranked among the first class of predispo- 
sing causes. Another predisposition is the inter- 
course between the two sexes. One of my colleagues, 
a professor in this institution, has mentioned to me 
numerous examples of students who were seized with 
the cholera after having visited a brothel. All those 
who have studied the disease at Warsaw, in Russia, 
and other places, have observed the same fact. Con- 
valescence is another predisposing cause ; persons 
convalescent from disorders pertaining to the gastric 
system, or on the point of becoming convalescent, are 
always exposed to the cholera ; but we have not ob- 
served that this was one of the most powerful 
predispositions, or, at least, we have been able to 
elude it, by subjecting our patients to a severe regi- 
men. I think, therefore, that such persons are not in 
danger unless they commit some excess which causes 
indigestion ; a thing, indeed, which happens too often. 
To these predispositions, I will add that of patients 
who have for a long time been suffering from some 
severe malady. 1 am led to this conclusion, because 
numbers of my old patients who had been completely 
cured of intermittent fevers or of inflammation of the 
bowels, have been returned to me now. 1 have ta- 
ken particular pains to ascertain with what diseas- 
es they had been afflicted before, and ascertained al- 
most uniformly that the)' were affections of the gas- 
tric system. 1 have also remarked, that numerous 
persons who had been attached to the army of the 



260 LECTURES ON 

north, having passed some time itl the hospitals, 
where they took sulphate of quinine, some of them in 
very large doses, easily became victims to the chole- 
ra; but I have not been able to ascertain whether 
these caes were attended with the previous diarrhoea, 
or with accidental indigestions. These are the princi- 
pal predisposing causes. 1 will here add, that persons 
in apparently good health, and who had experienced 
none of these predisposing causes, having been attack- 
ed suddenly, 1 have endeavored to investigate the mat- 
ter thoroughly, without contenting myself with the first 
details given me by the patients. I observed that 
they voided worms, and 1 discovered a great quantity 
in those who died. I believe we have had seven or 
eight cases of those attacked by cholera, w 7 hen they 
believed themselves perfectly well ; but I cannot con- 
sider a person, who is troubled with worms, as en- 
joying good health. 

Manner of Attach 
I here divide the malady into primary and secon- 
dary. There are, as you know, three great sections 
of the digestive canal ; the upper consisting of the 
stomach, which contains the duodenum : the middle 
containing the small intestines ; and the lower sec- 
tion, in which are found the colon-, coecum, and the 
rectum. You know that all inflammations of the in- 
testines predominate sometimes in one, sometimes in 
another of these sections. The cholera, then, is not 
exempted from these laws ; we have observed the 
commencement of the malady in one or the oth- 
er of these three sections of the digestive canal. I 
shall speak first of the attack in the lower section, 
these being the most frequent. The patients experi- 
ence slight attacks of colic, or sometimes nothing 



THE CHOLERA. 261 

more than a slight pain in the abdomen, which pre- 
cedes an evacuation ; many are seized all at once with 
an inclination to go to the privy, and there dischar- 
ges are made promptly and without pain. The canal 
empties itself at once ; and some persons, habitually 
constipated, are much pleased to find their passage 
open. As soon as the intestine becomes empty, the 
characteristic results of the cholera take place. The 
matter voided has a milky appearance, and some- 
what resembles a decoction of rice or oatmeal \ it is 
often tinged with bile, and I have constantly noticed 
that it contains particles of mucus. After this, all the 
symptoms and characteristics peculiar to the malady 
which I have just described, make their appearance, 
The patients are seized with cramp ; the extremities 
become cold ; nausea succeeds, and is rapidly follow- 
ed by vomiting, as we recently observed in the case 
of a patient, who, though he experienced only a 
slight nausea at the commencement of our visit, 
vomited abundantly before we left him. I proceed 
now to the attacks of the disease in the middle section, 
and the small intestines. The patients experience 
flatulence, violent workings and heat in the intestines 
for several days ; they have also slight colic, and a 
sort of uneasiness which they find it difficult to de- 
scribe. They, however, preserve their appetite. Soon- 
er or later the diarrhoea ensues, and the symptoms 
already noticed as occurring in the lower section, 
manifest themselves here. The attack of the mala- 
dy commences less frequently in the upper section ; 
in this case the patients are constipated ; they experi- 
ence some nausea and irritation of the stomach; they 
are forced to vomit, which they do at first without 
pain, unless there have been previous predispositions 5 



262 LECTURES ON 

after this, the vomiting becomes painful ; cramp takes 
place in the upper extremities ; the throat becomes 
dry, hot, and sore; the muscles of the jaw are also 
affected with cramp ; and after this, the other symp- 
toms of cholera appear. 

There is still another way in which the disease at- 
tacks the patient : this is by the nervous system. In 
this case there is no derangement of the digestive ca- 
nal ; the persons thus seized, experience a dizziness 
and fall senseless. Many soldiers have been at- 
tacked in this way ; and there have been cases of it 
also among the citizens. Persons thus taken with 
the cholera, fall as if struck by lightning, and in nu- 
merous instances have died immediately. A ques- 
tion here arises, — Does the disease, in these cases, 
really commence in the nervous system. Was there 
not previously a general irritation in the digestive 
canal, which produced a reaction on the nervous 
system ? I am inclined to this last opinion. It is 
certain, at any rate, that numbers who are seized at 
first with dizziness, sudden loss of strength, relaxa- 
tion of the muscles, and fall, recovering from these 
attacks, are taken with vomiting, the first sign of the 
malady, and then experience severe colic. These 
are the facts I have been able to gather respecting 
the manner in which the disease first declares itself. 

When the malady is secondary, it appears towards 
the close of a violent inflammation, or even in a con- 
valescent person. In a patient suffering from some 
acute disease, the cholera commences ordinarily by 
diarrhcea, and after that the other symptoms appear. 
The pulse is feeble, and the remains of fever, which 
would probably have disappeared in two or three 
days, are at once extinct ; the patient becomes cold, 






THE CHOLERA. 263 



and the symptoms of cholera declare themselves in a 
manner too evident to be mistaken. Convalescent 
persons are usually attacked in the lower section, and, 
by looseness of the bowels, and having no fever, slow- 
ness of the pulse and coldness of the extremities take 
place the sooner. Inflammatory diseases of the lungs 
seem to be a preservative ; and it has been remarked? 
that persons troubled with asthma escape the cholera ; 
this must not, however, be entirely trusted in, as there 
are phthisical patients who have a sort of diarrhoea, and 
if they had this predisposition in the time of cholera, 
they would doubtless be attacked. Thus it appears, 
that persons suffering from diseases of the stomach or 
bowels, are most strongly predisposed to the chol- 
era. 

Symptoms. 

The better to explain the symptoms and character- 
istics of this malady, 1 shall make the following divis- 
ions of them ; 1st, Those w T hich come to our knowl- 
edge by the information of the patients themselves ; 
2d, Those inferred from the exterior aspect of the pa- 
tients ; 3d, Those resulting from the nature of the evac- 
uations. First series — Those patients who are able to 
describe their condition, give us an accurate detail of 
what passes within them. They experience an inver- 
sion or upturning of the lower part of the abdomen, 
with violent heat and burning concentrated near the 
epigastrium. Those who are physicians, say that they 
feel all their blood rushing to the interior of the abdo- 
men ; such are their expressions ; others imagine that 
they feel electric sparks, which occasion much pain, 
and which are followed by uncommon heat ; then 
comes an extreme heaviness, with a weakness of the 



264 LECTURES -ON 

muscles, so that the~patients cannot move. With 
the exception of complete apoplexy, there is no dis- 
ease which renders the body so heavy and so lifeless, 
as the cholera ; the patients have no power of motion ; 
they seem to be a mass of lead or stone ; they can 
only stir the feet and hands, but cannot raise the trunk. 
This is easily conceived, for the principal point of irri- 
tation is in the digestive canal, and must react on the 
spinal marrow and muscles of the body. Their dis- 
charges are not very painful, for they are not accompa- 
nied by tenesmus, or desire of going to stool, as in ca- 
ses of ordinary dysentery, but are made with ease, and 
almost without the volition of the patient. The col- 
ics exist, nevertheless, but do not seem to occasion the 
discharges which sometimes take place even when the 
colic is not felt. The discharges and colic are gene- 
rally accompanied by cramp. These cramps are al- 
ways very painful, and it is these which especially ex- 
haust the patients, and are by them the most dreaded. 
The pain is manifested by the shrieks of the sufferer. 
The cramps do not affect the members alone ; they 
also manifest themselves in the muscles of the back, 
which are placed along the vertebral column. The 
patient always feels a considerable irritation in the re- 
gion of the stomach and the epigastrium, which is, 
perhaps, felt more than the colics ; it oppresses the 
patient, and prevents respiration ; and he seeks to be 
relieved from it by placing a cushion under him, so 
as to make the breast prominent. A strong contrac- 
tion appears in the face. Vomiting gives relief, and 
many of the patients desire and provoke it. The vom- 
itings go on, continually increasing, with compression 
of the epigastrium, and difficulty of breathing ; and, 
with these symptoms, come cramps in the limbs and 



THE CHOLERA. 265 

jaws, and sometimes in the muscles of the eyes- The 
knowledge of most of these symptoms is due to the 
declarations of the patients themselves. 

Let us proceed now to the symptoms entirely ex- 
terior. You observe, in the first place, signs which 
the patients do not speak of. The muscles are 
strongly marked under the skin ; the eyes are hollow, 
dry, and sunken ; after some hours, the consistence 
of the eyeball seems to be dissolved ; and one would 
say the eyes were turned inward by means of a thread. 
The aspect of the patient is hideous ; the face very 
soon loses its fulness, and is contracted in a manner 
peculiar to these affections : but what causes the 
greatest astonishment, is the livid hue which spreads 
-itself over the countenance as the disease advances. 
The extremities are cold ; the tongue is usually pale, 
chill, broad, and flat; the breath cold, and the pulse 
feeble; the words are rather breathed than pronoun- 
ced. The patient remains motionless, on the back ; if 
you force them to lay upon the side, they cannot con- 
tinue so long, but beg to be laid on their back, so that 
the breast may be raised. While the body thus remains 
-still, they move the feet and hands, uncover the breast, 
complain of a fire within, and tear off the poultices 
and other warm applications placed on the stomach ; 
they turn from one side to the other, but are not able 
to rise up. The color becomes darker and darker, 
and is soon livid. It varies, however, according to 
vthe natural complexion of the patient. Dark com- 
plexions become black or bluish ; but those which 
are more transparent turn yellow, taking the color of 
bad gilding. This is followed by cessation of the 
.pulse, which 1 shall call asphyxy. The pulse grows 

..weak -rapidly, and sometimes disappears in three 
23 



266 LECTURES ON 

hours, or even less. As soon as the pulse begins to 
grow feeble, the patient falls into the heaviness 1 have 
referred to : there are cases, however, in which he 
still preserves his strength when the pulse is extinct, 
and is even able to raise himself up, and go from one 
place to another $ but this strength is soon lost, and the 
unhappy person falls powerless. After the cessation 
of the pulse, the black hue manifests itself with vari- 
ous rapidity, sometimes at the end of two or three 
hours, sometimes even in less ; this depends upon the 
promptitude with which circulation ceases. When a 
patient thus affected is examined with a stethoscope, 
a slight tremor is perceived, similar to that in a dying 
person, or a pregnant woman. These are the char- 
acteristics by which this affection is discovered. 
When the patient throws up nothing but the aliment 
he has taken, this vomiting cannot be said to be caused 
by cholera ; neither is the voiding of local matter any 
bign of it ; but when these symptoms are followed by 
that kind of matter 1 mentioned before, there can be 
no doubt of the existence of cholera, whatever pains 
the patients may experience beside. I insist upon 
this point. A more foetid smell arises from this mat- 
ter towards the last, than at the commencement of 
the malady. The matter changes its character du- 
ring the progress of the disease : it grows thick when 
the sickness is long continued ; but is, at first, ex- 
tremely thin. A noise is heard in the intestines, and 
the matter, tinged with bile, is rapidly voided. In 
some cases, this appearance of bile continues to the 
last. It is important to pay attention to this circum- 
stance, in order not to be deceived. The cholera may 
be always recognized by the appearance of whitish 
gelatinous particles in the evacuations. Attention 



THE CHOLERA. 267 

must be paid rather to the affections than the pains, 
for nothing is more variable generally and in particu- 
lar cases, than the sensibility of our interior organs. 
There are persons who suffer much from the slightest 
inflammation ; others undergo severe diseases with- 
out suffering. Among those attacked with cholera 
some pass through all the different stages without 
pain ; others are agitated, and suffer in the limbs, or 
have very distressing cramps. The pain of the cramps 
varies according to the sensibility of the individual ; 
some are attacked without moving a muscle ; others 
utter horrible shrieks. Hence the importance of at- 
tending to the fundamental characteristics of the dis- 
ease, and these cannot be inferred from the sensibili- 
ty of the patient. Slowness of circulation, extinc- 
tion of the pulse, coldness of the extremities, livid 
color of the face, are the characteristics which it im- 
possible to mistake, and are the symptoms upon which 
we must fix our attention. When called to a patient^ 
if you find his evacuations white, and a diminished 
circulation, be sure the cholera has commenced. 
This is the object of my first lecture. To-morrow I 
shall occupy myself with the progress and treatment 
of the malady. 



268 LECTURES ON 



BROUSSAIS' SECOND LECTURE ON THE CHOLERA 
MORBUS. 

This second lecture, in which the learner! Profes- 
sor proposed to develope his doctrines in full, drew 
together a larger crowd than attended the preceding, 
(19th April) 

Gentlemen, 

In the lecture of yesterday, I imparted to you 
some ideas, which I had collected, upon the cholera 
morbus. I shall recall, in a few words, the most im- 
portant parts of that lecture. 

We have seen that the cholera is probably a very 
ancient malady, since the name of sporadic cholera 
has been given to it, although it differs greatly from 
that disease in its character of an epidemic ; for the 
sporadic cholera is scarcely ever developed, except in 
the summer, under the influence of irritating causes 
very easily averted, and is neither propagated by in- 
fection, nor contagion. On the other hand the chole- 
ra morbus is certainly propagated by a kind of infec- 
tion which it is difficult to characterise. Still it is 
proved to exist, as I showed you in my first lecture, 
and we are forced to admit it. I mentioned next the 
predispositions to cholera, which reduce themselves 
to an uncommon irritability, or a morbid irritation of 
the digestive canal. I also pointed out to you the de- 
termining causes, which are, all kinds of violent sti- 
muli that cause any considerable derangement in the 
act of digestion. I then directed your attention to 
the manner in which the disease commences its at- 
tacks. You undoubtedly remarked that there was ? 



THE CHOLERA. '269 

almost always, as the patients themselves avowed, 
some disorder of the digestive canal ; but that the 
malady sometimes commences in the nervous system 
by loss of the power of motion, or of the intellectual 
faculties. I added, however, that 1 was by no means 
convinced that those patients, in whom the disease 
made its appearance under the latter form, had not 
already experienced some derangement of the diges- 
tive canal : I was therefore obliged to leave this ' 
point undecided. 1 next showed how the attacks 
commenced in the three principal sections of the di- 
gestive canal. There are, then, four different ways 
in which the disease commences ; by the three prin- 
cipal sections of the digestive canal, or by the nervous 
system ; which last, I am of opinion, may be the ef- 
fect of some previous but undiscovered affection of 
the digestive canal. After this, we examined the 
characteristic symptoms of the malady. That you 
might the better remember them, and to avoid all 
mistake, 1 classed them in the following order: 1st. 
The symptoms, which came to our knowledge by the 
declaration of the patient of what he has perceived 
in himself; for this malady always commences by 
some derangement, and these are the atfections of 
which the patient is able to give an account. 2d. 
The symptoms discovered upon examining the body 
of the patient. 3d. The nature of the evacuations. 
1 fixed your attention with care upon this point, be- 
cause it is of great importance in recognising the dis- 
ease. 

We will now proceed to the question, it in case 
the cholera be arrested in its earliest stages by a pro- 
per and well directed medical treatment, this can be 
considered according to the rules of good logic to 

23* 



270 LECTURES ON 

constitute a particular disease in every case ; I am 
of opinion it cannot be, and these are my reasons. 
For example, if a man is running to throw himself 
into a river, and is met by a friend who removes the 
cause of his sorrow, would you say that this man has 
been pulled out of the river ? Certainly not. Still 
it is not the less true that he would have been drown- 
ed, but for the intervention of his friend. This is pre- 
cisely the case of those in whom the progress of the 
cholera has been arrested ; they were hurrying on to 
death, and you have stopped them. Still their pro- 
gress had already commenced. We must consider, 
then, 1st. The progress of these affections ; 2d. The 
examination after death; 3d. The prognostics ; 4th. 
The treatment. These will form the subject of the 
present lecture. 

Progress of the Malady. 

It is difficult to discover any absolute, independent, 
and unvarying progress in the cholera. It is worthy 
of remark, in the first place 7 that the spontaneous chol- 
era is always the most dangerous. M. Gravier, phy- 
sician of the King, at Pondicherry, having observed the 
disease at Calcutta, was the first person educated at 
the physiological school, who applied the principles of 
this school to the investigation of the cholera. M. Gravi- 
er lamented the bad result of a treatment by stimuli, 
composed of pepper, brandy, cinnamon, musk, and 
ginger, applied in such cases ; and he proved that a 
greater number of cures could be effected by keep- 
ing the patients upon rice-water, after having bled 
them. He could obtain neither leeches, nor ice, nor 
any of the means which you have seen employed here ; 



THE CHOLERA. 271 

and besides this, the malady discovered itself in thou- 
sands of individuals, so' that he was only able to em- 
ploy two or three general means against this devasta- 
ting scourge. The same embarrassment recurs in ev- 
ery instance of a great epidemic. It is evident, then, 
that by this anti-phlogistic treatment, of which the 
basis was copious bleeding, and by adopting rice-wa- 
ter for the beverage instead of brandy and other 
stimulating drinks, M. Gravier cured more than half 
his patients, while scarcely one per cent was saved by 
the method adopted before. Still M. Gravier has con- 
fessed, with an extremely laudable candor, that bad 
treatment was better than to abandon the disease to 
itself; for there was no case on record of the cholera, 
thus abandoned, terminating otherwise than fatally. 
This fact was noticed in a communication by M. Gra- 
vier on the subject, which was showed me in manu- 
script, for my opinion, in 1823, or 1824 . 1 forget the 
precise epoch, but the article will be found in the ar- 
chives of the Faculty of Medicine. M. Gravier has, 
since then, sent me a great number of notices upon the 
cholera, from which an article was formed , which ap- 
peared in the ' Annals of Physiological Medicine,' for 
the year 1827. The observation of M. Gravier, is 
conformable to our experience ; this terrible malady, 
when abandoned to itself, is uniformly mortal, while it 
is curable in different degrees, according to the treat- 
ment, and the conditions by which it may be modified. 
There are three different ways, then, in which the dis- 
ease may be treated. 1st. By pure stimulus. 2d. By 
a stimulating and debilitating treatment, employed si- 
multaneously or alternately. 3d. The physiological 
treatment. 

The disease, abandoned to itself, is always fatal. 



272 LECTURES ON 

and appears with the following symptoms : — When 
the affection has discovered its peculiar characteristics, 
the patients have continual vomitings and evacuations ; 
the pulse grows feeble by degrees, and finally disap- 
pears ; as soon as the pulse has become extinct, the 
blue color appears, proceeding from the extremities to 
the centre ; the evacuations cease, and the irritability 
disappears throughout ; the intellectual faculties, which 
had been preserved in a wonderful manner, for a long 
time, &in spite of the sinking of the patient, are now lost. 
Of these unhappy persons, some die in a sort of agony 
of short duration, which is announced by a strange res- 
piration, which 1 should rather term a laborious heav- 
ing of the stomach ; others expire suddenly in endeav- 
oring to move themselves, or in the moment of being 
placed upon a seat, or raised up to change the posi- 
tion. Such is the termination of the malady. As to 
its duration, the term varies a little, but not much, for 
the disease is circumscribed within very narrow limits ; 
it is scarcely ever known to last longer than three days 
when left to itself; and often terminates fatally in two 
or three hours ; that is to say, the phenomena of vom- 
iting, evacuations, feebleness of the pulse, coldness of 
the extremities, blackness, and agony, advance some- 
times with great rapidity, sometimes with a degree of 
slowness, which is generally confined to the space of 
three days. The disease is modified in the first place 
by pure stimuli, I mention this method first, because 
it has been adopted in India, at Calcutta, and in the 
English settlements generally, for the simple reason, 
that Brown's system had absorbed the whole English 
practice, and the physicians who came from England 
were necessarily obliged to apply their theory to the 
patients, in every possible climate ; still, this method 



THE CHOLERA. 2735 

was more injurious in the tropics, than elsewhere. 
This method, purely stimulative, consists in administer- 
ing spirituous liquors, such as brandy, rum, gin, not 
only pure, but impregnated and saturated with aro- 
matics and irritating substances, such as cinnamon, 
nutmegs, cloves, &c. Madeira wine is every where 
employed, having been brought by land, and being ex- 
tremely powerful, as the chemists know, since its fer- 
mentation is not finished ; and there remains a consid- 
erable quantity of sugar ;> besides this, it is found in ev- 
ery part of the world. Some narcotics are also used ; 
but the Madeira wine and brandy are always impreg- 
nated with aromatic substances, such as musk, pepper, 
ginger, and cloves. The mortality under the influence 
of this treatment, is frightful.- There are, however, a 
few instances of a happy termination of the malady ; 
such are the resources of human nature, that the pa- 
tient sometimes owes his safety to the very circum- 
stance w r hich seemed about to put an end to his life, 
and this by means of revulsions. 

It must be confessed, that our information respect- 
ing the phenomenon of revulsions, is much too limit- 
ed ; because these revulsions depend upon the sym- 
pathies or co-operation which exist between the or- 
gans ; and this study has been abandoned entirely in 
favor of experiment. In this, there is nothing aston- 
ishing ; it is natural to the human mind. Whenever 
any new method comes greatly in vogue, it is easily 
seized upon by men of science and of high reputation, 
and they must be satiated with it before they can 
perceive the inconveniences which result from it. 
Hence, great numbers became victims to the system 
of Brown, before its dangers were discovered. 

It is then proved that those who are treated by ex- 



274 LECTURES ON 

eessive stimuli may experience a favorable crisis of j 
their disease, and this crisis is brought about by 
sweating, and it is particularly that kind of sweating 
which is induced by wine, punch, spirituous liquors, 
and brandy, which saves the life of the patient. 

These are the advantages of this treatment. I shall 
now mention its inconveniences. The first is, that 
this method, compared with another which I shall 
speak of, is infinitely more dangerous, since it is at- 
tended with a much greater number of deaths. An- 
other is, that those who are cured by the stimulating 
method, still preserve a morbid state c? the digestive 
canal, and even of the whole system, which continues 
through the rest of their life. 

The eclectic or mixed method of treatment, is ad- 
vised by erudite, but timid persons, and is adopted by 
the mass of physicians, because their ideas upon the 
nature of the disease are not well determined. It 
consists in first bleeding the patients, and after that, 
in provoking either upwards by ipecacuanha or tar- 
tar emetic, or downwards by calomel, or other pur- 
gatives ; and in endeavoring to produce perspiration 
by means of sudorifics, baths externally applied, or 
heat applied internally. .Narcotics are then admin- 
istered for the pain or movement of the nerves ; but 
they are given before the inflammatory state has been 
sufficiently reduced. This method is attended with 
more favorable results than the former ; and it has 
prevailed in Paris among those physicians who were 
not educated at the physiqlogical school, and who 
have not been accustomed, as we have in this school, 
to compare continually the effect of the modifications 
in the different maladies with the progress of the 
symptoms, and the results obtained from examina- 



THE CHOLERA. 275 

tion after death. 1 shall not enter into any farther 
details of this method ; it is much employed, and it 
is sufficient to refer to it. I ought to remark, how- 
ever, that its results are more favorable than those 
of the first method. I hardly know, indeed, if a com- 
parison can be drawn between the two ; for the re- 
sults of the first have been attended with hardly any 
success ; none, indeed, unless in comparison with 
the ravages of the cholera when left to itself, which 
is known to be almost uniformly fatal, it is better, 
in effect, to expose the patient to extreme stimulus, 
than to leave him to perish ; but it is better still to 
weaken him by bleeding before resorting to stimulus, 

[Patients die by this treatment a little more slowly 
than by the preceding method. (Lively sensation)] 

The physiological method, which consists in the 
use of emollients and relaxants, and of stimulus ap- 
plied externally, in proportion to the susceptibility of 
the patient, appears to us preferable to the others ; 
and I shall proceed to describe its rules of application. 
I wish you to take particular notice here, that 1 am 
not speaking of the treatment of the disease, but only 
of its progress. I simply wish to explain to you, that 
there is a great variety in the progress of the malady ; 
that it is subjected to modifying circumstances ; that 
when abandoned to itself, it has not the same result 
as when treated medically ; and that its result differs 
according to the manner in which it is treated. I 
wish to fix your attention upon these points without 
going into any further details ; for you have all the 
same opportunity for examining the disease as my- 
self. 

Examination of the body after death. 

When these attacks prove fatal to the patient, it 



276 LECTURES ON 

is very natural to open the body in order to discover 
the first, or, at least, the secondary cause of the dis- 1 
ease, which has extinguished life. 1 make a distinc- 
tion here between the examination of those who I 
were not subjected to any treatment, and those who 
were treated in a manner to delay death a little with- 1 
out finally preventing it When we examined the I 
bodies of persons who died after having exhibited j 
symptoms of the cholera morbus, it was necessary to l 
take account of their former maladies and the traces j 
they had left upon the organs. We have here, as in j 
all the hospitals, many instances of the patients who 
are brought in alive, but who die before they can be | 
subjected to any treatment. These patients are black 
when first presented to us — generally completely j 
black. The muscles are very prominent in the body | 
after death, and in a state of contraction, like those j 
of a wrestler who is making an effort to rise from the 
ground ; and they have been thus described with 
great accuracy in a work just published. On open- 
ing the body, we find in the brain a considerable in- 
jection in the menynges or membrane, The injec- 
tion of the cerebral substance is not generally in pro- 
portion to that of the menynges ; that is to say, the 
membranes which envelope the brain. This is near- 
ly all that is worthy of remark in the brain ; there is 
almost always a little waterinessin the cavity of this 
membrane ; but, in general, this is not abundant; 
but, on the contrary, a very considerable quantity is 
found in those patients who have been treated for a 
certain time, and who have been bled. We remark 
very disagreeable symptoms in the throat also, when 
these congestions of the blood in the head are form- 
ed.; .there is a stiffness, dryness, and sometimes a 



THE CHOLERA. 277 

choaking up of the ganglions ; otherwise there is no 
increased softness, nor dissolution of the mucous 
membrane of the mouth, or of the oesophagus. The 
stomach is ordinarily very much disordered, some- 
times black, sometimes brown, and sometimes red- 
dish. Its vessels, extremely developed, exhibit rami- 
fications of a black color; and between these vessels 
the mucous membrane is softened, and almost dis- 
solved. Meanwhile, it is always necessary to take 
notice of the previous diseases. We have noticed 
that habitual drinkers, or those who have exposed the 
stomach to any habitual excess, exhibit frequently a 
softness and even a very considerable destruction of 
the mucous membrane ; and this alteration does not 
exist in persons of sober habits. The duodenum is 
rarely disordered to any great degree, unless the pa- 
tient had been previously affected with complaints of 
the stomach and bowels. The small intestines are 
very much filled up; but here occurs a very remark- 
able circumstance ; for we must make our distinc- 
tions, and speak of the symptoms in reference to the 
appearance of the body after death. Those patients 
who had very abundant evacuations, (and these take 
place to a frightful degree both by vomiting, and go- 
ing to stool, in those w 7 ho have no medical treatment, 
so that their strength is exhausted and life passes 
away,) those patients exhibit the redness of the mu- 
cous membrane of the intestines less apparently; it 
exists, however, from the commencement to the end 
of the canal, but not very distinct. An immense 
quantity of the liquid which is evacuated, is found in 
the interior of the digestive canal. There is an en- 
tire analogy between the matter vomited and voided 
downwards, after the fecal matter and bile have 
24 



278 LECTURES ON 

passed away, and this liquid which is found in the 
cavities of the digestive canal. We have had an op- 
portunity of examining patients in whom these secre- 
tions produced by cholera had not been repressed by 
the efforts of art, in consequence of the physicians 
not having discovered, during the first moments of 
the disease, the malignity of certain evacuations. which 
might be mistaken from slight accidents or from de- 
rangement of the gastric system ; these patients ar- 
rived here in the last extremities before they could 
receive any treatment. We were much surprised 
at these examinations, to discover a sort of mucous 
formation, and a large quantity of fluid resembling a 
fuliginous solution which filled the intestines. The 
mucous membrane appeared a little paler than usual, 
a slight redness merely pervading its whole extent. 
From the upper orifice of the stomach, down to the 
anus, no part discovered this redness ; and we have 
only been able to ascertain that when the patient had 
experienced a previous irritation cf the digestive 
canal, the stomach and bowels had the appearance 
of greater redness and alteration. The bladder was 
contracted and gathered into the pubis, a circum- 
stance not at all surprising, since the abundance of 
the intestinal evacuations must, of necessity ; have 
exhausted the sources of urine: but there was no 
appearance of inflammation. 

Those subjects in whom the malady had been 
treated in such a manner as to prolong it without fi- 
nal success, exhibited appearances a little different, 
These affections commonly cease, or, at least, are 
modified, when the patients are subjected to medical 
treatment. When they are well treated, the cessa- 
tion is followed by their cure, but when treated less 



THE CHOLERA. 279 

advantageously, they are sometimes cured, sometimes 
not. When they are not cured, it is found that the 
inflammation is. more strongly marked. The redness 
which was a slightly pale, and resembled in some de- 
gree the color of the flower called hortensia, is here 
very bright ; it is scarlet, or even bordering upon 
black ; there are portions, even in the digestive canals 
which appears gangrenous. Thus, when the disease 
made its first attacks in the gastric region, a frightful 
derangement is found in the stomach, the mucous 
membrane of this organ appearing entirely destroyed 
and very black. When the disease commenced in 
the small intestines, the mucous membrane is some- 
times gangrenous ; in other patients it is completely 
destroyed. The liquid contained in the digestive ca- 
nal, is less fluid, less white, less opaque, adheres to 
the mucous membrane, and approaches the condi- 
tion of a false membrane. The intestines are less 
humid, less black, and more difficult to separate from 
each other. The glands of Peyer and Brown, some- 
what more swollen, present the appearances of ileo 
colic. 

In a word, the ordinary symptoms of disease of the 
stomach and bowels appear. The brain is crowded 
not with blood, because the patients have often lost 
much by bleeding. It is more humid, and fewer 
drops of blood are discovered when its substance is 
cut ; the ventricles are more moist, and sometimes 
abundantly supplied with watery matter* We have 
never found it inflamed, nor have we ever remarked 
any arachnitis, properly so called. We have seen 
congestions of blood and watery effusions, but nev- 
er distinct inflammation. As to the heart, we found 
it in the first subjects, choaked up with thick blood, 



280 LECTURES ON 

its partitions thickened, and upon being cut. blood, 
less coagulated than we expected, followed the knife 
in drops, and even in a stream ; but there was no 
marked inflammation in the internal membranes of 
the heart and of the large vessels. When the patients 
lived for some time after the secretions of the digest- 
ive canal had ceased to be so abundant, the bladder 
was not so much contracted as in the case of those 
who had died during the evacuations. It was entire- 
ly filled with urine, without inflammation, a circum- 
stance which throws much light upon the cause of the 
cessation of urine, which must be attributed to the 
deviation of the watery fluids which go to the intesti- 
nal surface instead of following their course as in the 
healthy condition. The muscles are sticky, dry, and 
emaciated. The lungs present no remarkable ap- 
pearance. 

I repeat here, we must give attention to the previ- 
ous diseases. What are we to conclude from all this? 
That the cholera morbus is essentially an inflamma- 
tory affection. This is my conclusion. This inflam- 
matory affection attacks the whole extent of the di- 
gestive canal, from the throat to the anus. When- 
ever it is intense, when it is very red, as it commonly 
is when the malady has lasted a long time and the 
evacuations have ceased, when it is less bright in col- 
or, as is the case when death takes place in the midst 
of abundant evacuations, it is always genera), and 
there is no part of the canal which is exempt from it. 
I insist upon this proposition, which is in oppo- 
sition to many reports upon the cholera. I in- 
sist upon it, because it is true, and serves to verify 
many important points. Some persons maintain that 
there is no inflammation in the digestive canal, and 



THE CHOLERA 281 

they rest their position on the fact, that some patients 
have died during abundant evacuations, in which case 
the external membrane of the digestive canal is not 
scarlet ; but the inflammation does not the less ex- 
ist, and the abundance of the secretions and evacua- 
tions explain sufficiently its want of redness. Do not 
conclude from this, however, that I only consider the 
disease in relation to inflammation. I set aside here 
that unknown cause referred to in my first lecture, 
and which I compare with that of the small pox, 
which is equally unknown ; what we see in the 
small pox, as in the cholera, is the inflammation 
which these maladies produce. 

Thus, in a word, the cholera morbus, as we believe, 
is a general inflammation of the internal membrane 
of the digestive canal, of which the first determining 
cause is unknown, while the predominating and sub- 
sequent causes may be comprehended. And there is 
an advantage in this ; for if the first causes cannot be 
discovered, we can, at least, distinguish the seconda- 
ry causes, a circumstance of great importance, and 
which ensures us much success. 

Prognostics. 

These are, 1st, The previous health of the patient. 
Persons in good health are easily cured, when the dis- 
ease is treated in time. The age of the patient, — 
Young persons are cured more easily than the aged. 
The sex — Upon this point, it has been impossible to 
make any positive or satisfactory comparisons. The 
moral condition — I have already made some remarks 
on this point, and all" our observations tend to confirm 
them. The prognostics depend, 2dly, upon the na- 
ture of the commencement of the disease. If it be- 
24* 



282 LECTURES ON 

gin in a downward direction, by a gentle diarrhoea, 
there is time to treat it, and arrest its progress. And 
at this moment a vast number of these affections are 
stopped at their commencement, by the skill of the 
physicians in Paris. The disease, when thus arrest- 
ed, is called cholerine. Thus, some trifling consola- 
tion is offered to the public. The physician says to 
the patient, e you have the cholerine ; you have a 
slight diarrhoea, but you have not the cholera.' And 
when it is checked, he does not say, ' you have had 
the cholera.' Thus he avoids terrifying the patients, 
who are satisfied without being made to understand 
that they were victims devoted to the cholera, had 
not the necessary succour been lavished upon them. 
When the disease attacks the middle parts, the re- 
sult is the same. If it be confined to a slight relax 
and tension, it is easily checked. When the symp- 
toms predominate in the upper parts, and the diarrhoea 
has ceased, I venture the opinion, that the disease is 
more easily cured. When, on the contrary, it has 
lasted a long time, and the cramps, which are a proof 
that the inflammation of the intestines has extended 
to the spinal marrow, have commenced, when the 
patients are seized with great anxiety, agitation, and 
uneasiness through the whole extent of the abdomen, 
they are in much greater danger. When these symp- 
toms have disappeared, and there remains nothing 
more than vomiting and distress of mind, there is 
much more hope of recovery, 

All the symptoms have not the same importance. 
The congestions of the brain scarcely ever manifest 
themselves during the violence of the disease. The 
patients may appear to be in such a state of sinking 
and exhaustion as to cause the belief that there is a 



THE CHOLEHA. 283 

congestion of the brain ; but if you excite them, if 
you speak to them, they answer very well ; so that, if 
you have let fall any indiscreet expressions, you may 
have cause to repent it, when you see that the pa- 
tients have the full use of their faculties. On the con- 
trary, when the symptoms of the attack have ceased, 
and the moment when you flatter youself that the 
cure is about to commence, a very severe congestion 
of the brain may take place, unless measures are 
adopted to arrest its progress. 

When the malady is prolonged, when the pa- 
tient is revived from the state of asphyxia, and 
the dark color has disappeared, the tongue red, and 
the skin hot, the disease has changed its nature ; the 
patients exhibit all the symptoms of the diseases of 
the stomach and bowels, which we are called to treat 
every day. We here make this distinction : it is al- 
ways necessary in the treatment we adopt, to have 
reference to the modifications of the disease. When 
the patient has been revived from a state of stupor, 
asphyxia, and blackness, by means of stimulus, this 
disease of the stomach which ensues, is severe, and 
resolves itself into typhus. 

At this very moment, indeed, it is said that the ty- 
phus reigns in Paris, with the cholera, and the same 
thing is repeated upon the subject that was said in 
Germany, Poland, Russia, and the Levant. But if 
you wish to appreciate justly this pretended typhus, 
this typhoid fever which succeeds the cholera, and 
of which the most dangerous symptoms have been 
suppressed, you will perceive that this same fever 
should be subjected to the same treatment as the 
ordinary complaints of the stomach and bowels. In 
our hospitals, for instance, there is no typhus ; there 



284 LECTURES ON 

is nothing else than slight complaints of the stomach 
and bowels, which pass off in three or four days, and 
the patients call for food. In those halls, on the con- 
trary, where the patients have been revived by means 
of stimulants, such as punch and brandy, they perish 
in great numbers, after having been carried into an- 
other hall as cured of the cholera. They are report- 
ed in the bulletin as cured of cholera, and placed in 
a separate room as affected with typhoid fever, and 
nothing farther is said about them ; the attention of 
the physicians is given to the new subjects of cholera 
who arrive, and the first are forgotten. 

1 now pass to the treatment, which, for the sake of 
perspicuity, 1 divide in the following manner : — 

The Ancient Treatment or treatment of the spora- 
dc cholera. — Treatment after the manner of Brown. — 
Mitigated treatment, or eclectic, or vacillating (bascule) 
(laughter) ; I make use of a word which ex- 
presses my meaning, without intending to make any 
application. — Finally, Physiological treatment, such 
as we employ here. These are the four divisions we 
have made. 

Let us examine first the ancient treatment. In all 
the standard treatises, the following receipts are 
found. We are directed to administer abundantly to 
the patient a decoction which favors vomiting, that 
the bile may pass off, and after that when every thing 
that was wrong in the digestive canal is evacuated, 
the cramps and irritation must be allayed by narco- 
tics. This treatment has saved some individuals, but 
has not been so successful as to be generally adopted ; 
besides this, the practice of the middle ages has fallen 
into disrepute, and Brownism has taken its place, par- 
ticularly in those countries where the cholera prevails, 



THE CHOLERA. 285 

for the English physicians have carried there the ideas 
of Brown. 

Brownian treatment, — This consists in the use 
of stimulus. I have little to say on this head, having 
already referred to it before. I shall only add, that it 
cures very few patients. I will not say it kills them> 
because, when the cholera is left to itself no one es- 
capes ; and this treatment, in a vast number of cases, 
is succeeded by typhus, or disease of the stomach and 
bowels, which extends to a degree of typhus. 1 do 
not wish to accuse any one, but only to do justice to 
all. As to the means of treatment, I have pointed 
them out. 

The mitigated treatment consists of the following 
means. The physician seeks to restore heat to the 
patient, at the period of asphyxia, or if you wish tg 
go back to the diarrhoea which precedes, he seeks to 
remove it by means of rice-water, diascordium and 
opium. Sometimes, indeed, the force is moderate^, 
but it is impossible to prevent the malady from break- 
ing out. After the asphyxia and the blackness have 
made their appearance, the physician endeavors to 
warm the patient by external and internal applica- 
tions. For exterior, hot baths are used, and dry fric- 
tion, with aromatic and stimulating substances, hot 
bricks and flannel. The skin is irritated and stimula- 
ted continually, in the hope of recalling circulation. 
For the same purpose, hot drinks are internally ad- 
ministered. Some practitioners have no fear of the 
drinks being too strong. Like the followers of Brown? 
they give brandy and punch. Others, more timid, 
make use only of borage, or balm, and above all, of 
camomile, which has lately obtained a great credit. 
After that, they give something fortifying, acetate 



280 LECTURES ON 

of ammonia, ether, or substances containing alcohol 
If the patient experience nausea, opium is sometimes 
added. When a reaction is produced by these 
means, which does not always happen, the patient 
grows warm ; some hours afterwards, he becomes 
cold again ; the same methods are again employed, 
but he grows cold continually. 

But persons w 7 ho manage well, hasten to profit by 
the first appearance of warmth, and send the patient 
into another hall. Thus 1 saw, at a boarding school, 
a number of scholars who had been attacked, warm- 
ed again for the moment, and sent home to their pa- 
rents, where the disease immediately returned. It 
is possible, however, to maintain this warmth ; and 
when a continued reaction has been obtained, an in- 
tense irritation occurs ; less violent, however, than 
that produced by the hyper-stimulants of the Browni- 
ans. Others think that evacuations should be pro- 
moted by emetics. As soon as they see the quantity 
of liquid which inundates the digestive canal, they 
say, ' evacuations must be aided, 1 without reflecting 
that they will arrive at the absolute exhaustion of the 
strength, and that the irritation will be augmented. 
English and Polish physicians have been known to 
give, alternately, calomel to promote evacuation, and 
brandy to stimulate. Some cures have resulted from 
the treatment. 

1 cannot say what is the proportion of cures effect- 
ed by these different methods ; it would require many 
years of research to ascertain. It will perhaps be 
known at some future day, but at present, I can only 
state to you the most general facts. When, by the 
means 1 have spoken of, the patient is revived from 



THE CHOLERA. 2&^ 

his stupor, if these physicians discover much fever, 
they bleed, either with the lancet or by leeches ap- 
plied to the epigastrium : then, if the patient be too 
much weakened by loss of blood, they give him ether 
or seltz water ; in a word, the medicine is suggested 
by the symptom. 

These results are more favorable than those of 
Brown's treatment. It is the prevalent method in this 
capital, and to this we owe a great advantage in the 
mortality over other countries where the disease has 
appeared. 

We come now to the physiological treatment, which 
we employ. 1 wish to describe, and if possible, to 
j ustify it. We made, at first, some experiments with 
hot drinks and stimulants, moved, as we were^ by 
the coldness of the patients : but as these means did 
not succeed, we abandoned them, and have not re- 
curred to them. I watched the patients carefully; I 
gave them, not camomile, for I dared not go so far, 
but mallows, and similar things. They said to me, 
; I beg you to give me something cold ; I am tortured 
by the hot drinks ; I have a terible burning in the 
throat, and I beg you to cool it in some way.' Their 
countenance brightened in saying this, but they after- 
wards fell into a still greater dejection. I concluded, 
from examining the bodies, and from the confession 
also of the patients, that stimulants were of no use. 
1 then administered cold drinks ; the patients drank 
freely, but the evacuations redoubled in consequence. 
I recollected that ice had been employed to advan- 
tage in Germany ; but I only had a vague and unsat- 
isfactory idea of the manner in which it had been 
used. It occurred to me to diminish the drinks and 
give them ice. When the patients had copious evac- 






■288 LECTURES ON 

uations both ways, I caused ice to be given them to 
eat, with the injunction to swallow it. They took 
the ice with delight : the tongue was cold, the pulse 
extinct, and the body chilled. When the tongue is 
observed to become red, the skin to resume its color, 
and the blackness to disappear, the ice may be dis- 
continued and the drinks given ; but while the phy- 
sician is endeavoring to restore the moisture of the 
mouth and the interior of the body, the gastrite is de- 
veloped, reaction is going on, the nature ofthe inflam- 
mation is changed, and consists in a rapid congestion 
towards the digestive canal. The vomitings and 
stools continue, and the pulse is accelerated ; from 
being slight and hard, it becomes fuller and softer, 
the brown color of the skin passes gradually away, 
and one is surprised, the next day, to see the patient 
with the signs of commencing inflammation of the 
stomach and bowels, la the mean time, when he is 
troubled with thirst you may give him some drinks, 
which you may be sure he will absorb. The dan- 
ger is of filling the intestinal canal at the moment it 
is choaked up. When the asphyxia and blackness 
have disappeared, and the patient has recovered his 
strength, you conduct him slowly without stimulus, 
waiting till he has become slightly cold, and till the 
tongue, which had become a pale red, but not more 
pale than when it first grew cold, has recovered its 
ordinary color. This is the substance ofthe treat- 
ment for the interior. For the exterior, heat may be 
applied ; it should be directed to the lower extremi- 
ties. It is not well to accumulate heat upon tha 
breast : the patient cannot support it ; they have, on 
the contrary, a desire to uncover themselves, which 
seems to aid their respiration, and they derive sensi- 



THE CHOLERA. 289 

ble benefit from it, and express their satisfaction. If 
on the other hand, you force them to have the breast 
covered, if you place them under a blanket or down 
covering, they appear to suffer extremely, and beg 
you to uncover the breast a little. The public is still 
the dupe, in this respect, to prejudices which have 
been brought from Germany. I will speak here of 
friction : it is certain that there are establishments at 
Paris, where the persons employed in rubbing, sweat 
themselves, before they excite any perspiration in the 
patients. On the contrary, this stimulus only increas- 
ed the anguish of the sick, and chilled them after the 
first few moments, by leaving them uncovered. It is 
not enough to apply cooling substances internally, and 
heating ones without ; the inflammation must be com- 
bated ; and for this purpose we employ leeches. 
Bleeding can be rarely resorted to, the blood being 
very thick, and having somewhat the appearance of 
jelly. Its fluidity may be momentarily restored by 
rubbing the arm of the patients, or by plunging it 
into hot water ; but all this produces no essential re- 
sult. In order that the bleeding may be of any use, 
the patient must be taken in the earliest stages of the 
disease. I then cause leeches to be applied to the 
epigastrium and the lower part of the abdomen. The 
leeches draw nothing at first, but in proportion as 
circulation is promoted by the ice, and at the same 
time by emollient poultices placed upon the abdomen. 
A quantity of blood is taken by the leeches, so as to 
aid the cure. You will ask me, perhaps, how the 
want of ice may be made up? I answer, that nothing 
is so good as ice. Nevertheless, i think that small 
draughts of cold water may be of use. Besides this, 

there are in almost all places, persons who understand 
25 



290 LECTURES ON 

how to produce ice by artificial means, by using ox- 
ide of manganese, sulphuric acid, or muriate of soda. 
Ice must be procured, if possible 5 but if it cannot be 
obtained, the want of it must be supplied by taking 
small quantities of fresh water. Blisters and mus- 
tard seed poultices should be employed afterwards to 
prevent congestion of the brain. Leeches may be 
applied with advantage to the temples, and upon the 
jugular vein ; poultices and warm applications of 
mustard-seed should be placed upon the extremities ; 
and hot vapor baths should be used, at the same time 
applying ice and cold water. 

It may be said, perhaps, you are exclusive then. 
Will you allow us to give neither iEther nor Seltz- 
water to the patients who fall into syncope after 
bleeding ? I beg pardon ; I think this may be done : 
i would have the physician use stimuli when he per- 
ceives the pulse of the patient growing weak, pro- 
vided he has ice in readiness to calm its effect, I 
have done this myself, and believe it advantageous, 
and 1 have done this, though very seldom, in this 
hospital, since I cannot be here at all moments of the 
day, nor can I choose my attendants, to watch the 
patients without interruption. But, in spite of this, 
I have obtained very remarkable success, since at 
present we do not lose more than one patient out of 
thirty or forty, while at first we lost about one out 
of six. The proportion of cures has been since aug- 
mented, because the patients have been brought to 
lis before they had reached the last stages of the dis- 
ease. Thus, you observe, I do not absolutely reject 
any system of treatment. Some persons have pro- 
posed narcotic glysters with laudanum. I will now 
express my opinion upon this. In the commence- 



THE CHOLERA. 291 

ment of the disease, if a stifled sound ensues when 
you touch the abdomen, this proves that it is not air 
which prevails in its cavity, but that it is full of the 
mucous matterpf which I have spoken. If, in these 
circumstances, you administer glysters of rhatany, 
and other astringent substances, you will produce ir- 
ritations; the matter will not be detached, but will 
mount up again ; congestion of the brain will ensue 3 
and you will be in danger of witnessing very disa- 
greeable results : this practice must therefore be re- 
nounced. But when the patients have been bled, 
and their evacuations have been abundant, if they 
continue to experience pain in the lower part of the 
abdomen ; if they are effected with terror, agitation 
and uneasiness, it is time to administer narcotic glys- 
ters. You will then obtain remarkable success, 
while, if you administer the glysters prematurely, the 
result will not be satisfactory. As to the quantity of 
opium, this depends upon the system adopted by the 
physician. There are some who reject opium and 
stimulants ; others administer them in large doses* 
I prescribe but from five to ten drops of laudanum, 
I have given even forty drops when the patients were 
very much convulsed, but never any greater quanti- 
ty. This, then, is the substance of my treatment. 1 
allow no kind of warm drinks. The only time that 
I think them admissible, is when the patient begins 
to have an appetite. 1 then prescribe a cup of soup 
diluted with water, which revives the patient in an 
astonishing manner, so that he fancies himself cured. 
As to the length of time, we have had patients in this 
hospital, who have remained four or five days in a state 
of asphyxia and blackness; we expected, every mo- 
ment, that they would die, but still they have recover- 



292 LECTURES ON 

ed to the great astonishment of the assistants. We 
have had instances of the recovery of patients who 
had become black or dark colored, and this has been 
owing to the use of ice and cold drinks. 

I now proceed to the treatment at the time of pre- 
disposition. When a person, affected with irritabili- 
ty of the digestive canal, sees that the cholera has 
broken out in the place where he lives, he should 
commence by diminishing the quantity of this food 
at least one half. This is called the prophylatic treat- 
ment. Only a small quantity of vegetables must be 
eaten : I do not say that they should be entirely given 
up, but used very sparingly. You should eat eggs, 
veal, and poultry, and not drink much between 
meals ; and not at all, unless you are thirsty. Great 
moderation must be used in this respect. All kinds 
of uncommon and violent fatigue must be avoided ; 
and also sexual intercourse, which easily fixes the 
disease in feeble subjects ; the regular habits of life 
must be kept up, and not deserted for any invitation, 
nor upon any occasion. I have known many persons, 
who, after preserving themselves a long time from 
the malady, fell into some excess, and were attacked 
the next day, and some died in a few hours. All per- 
sons, or, at least those who have not uncommon 
courage and firmness of character, should avoid the 
sight of patients suffering with cholera, as there is 
something very frightful in the contortions of their 
countenance ; and one must be accustomed to attend 
patients, in order to behold, with indifference, so ter- 
rible a spectacle. Fruit and milk must be given up ; 
there are persons, however, who digest milk perfectly, 
and these need not renounce it. There are others 
who are constantly disordered by milk, which occa- 



THE CHOLERA. 293 

sions in them an almost continual diarrhoea ; besides 
this, there are others who regard coffee and milk as a 
daily purgative and such persons should abstain from 
it. I know there are some who say, " If I do not 
take coffee with milk, I shall have no stool," 1 an- 
swer them, " Give up your coffee and milk, should 
nothing pass you for a week." All passion must be 
avoided, as this gives rise to great inconveniences. 
Above all, a resource against terror must be sought 
in the moral powers ; for this malady, so terrible when 
suffered to progress, can, by attacking it in the very 
commencement, be made one of the least injurious 
from which human nature suffers. The cholera mor- 
bus, in fine, is one of those diseases which best 
prove the power of medicine. Had all the physi- 
cians in Paris agreed as to the manner of treating it, 
you would have seen wonders performed, and 
France would have been distinguished among the 
nations for effectually arresting the cholera ; but this 
is impossible ; the idea of uniformity of thought is a 
chimera, an utopia, to which no reasonable man can 
yield himself up. 

When the disease commences with some precurso- 
ry symptoms, this is truly the moment of triumph. If 
a man who has commonly one stool a day, perceives, 
all at once, a relax, in the middle of the night, with- 
out cause or motive, and that the evacuation of ordi- 
nary matter is followed by a white mucous substance, 
depend upon it, this man is attacked with the first de- 
gree of cholera. In this situation, it is very easy to 
cure him, as 1 have already ascertained. There are 
physicians w 7 ho are satisfied with prescribing brandy, 
astringents, diascordium, simarouba, and rhatany, 

with glysters and other things of the kind* They re- 
25* 



294 LECTURES ON THE CHOLERA. 

commend* also, a diminution of nourishment. Bi>t 
these are only half means. Go at once to your ob* 
ject, cut off the food, apply leeches to the anus, if the 
pain be in the lower part of the abdomen, and to the 
epigastrium if it be in the stomach. Make free use 
of the leeches, and of ice, and you are sure of suc- 
cess, unless you have to deal with patients whose vis- 
cera were previously disordered , and we must always 
except such cases. 

I repeat what I have already told you 5 it is an 
eternal truth — if your patients have organic affec- 
tions of long standing, above all, if they be aged, 
you must not flatter yourselves that a cure will be so 
easily effected 5 but when success is possible, you will 
obtain it. It is much more prudent to impose this re* 
gimen upon them, for two or three days, than to give 
them chicken and rice, with soup. Be severe, and 
make no change in your prescriptions, for if you au- 
thorise three mouthfuls, the patient will be sure to 
take fiv^e, and the whole fruit of your labor will be 
lost. 

This is all, gentlemen, that the actual state of my 
knowledge, and my ideas on the cholera morbus, al- 
low me to say to you, and I shall be extremely happy 
if you can derive any advantage from my remarks." 

[This discourse was followed by lively, and long 
continued applause.] 



CAUSES OF THE CHOLERA, AND METHODS 
OE PREVENTION. 

In commencing an inquiry as to the causes which 
produce the cholera, the first question that requires 
an answer, is, whether the disease is contagious or 
epidemic. Upon this delicate and difficult subject, med- 
ical men are much divided. They may be divided 
into three classes, who hold to different opinions. 

1. The first, though least numerous class among 
the intelligent medical men, are the exclusive conta- 
gionists, who believe that the cholera is communica- 
ted from an unhealthy body to a sound one, by ap- 
proximation, or actual touch. To this class belong 
also the great mass of the non- medical community — 
the civil authorities of towns and those who have the 
power to make and enforce quarantine regulations 5 
regulations which, as regards the prevention of chol- 
era, have been of no use, but, on the contrary, as 
facts fully exhibit, have been productive of immense 
evils. 

2. A larger class are the anti-contagionists, who 
believe that the cholera depends either on a general 
cause every where existing, or arises from numerous 
causes, the most powerful of which are, exposure to 
cold and humidity at night, and burning heat during 
the day, the abuse of stimulating liquors, bad food, 
want of cleanliness, &c. &?c. 

Some, like M. Schnurrer, suppose it is produced by 
a cause every where existing — the magnetic influence 
of the earth, which he calls the telluric power. 

Mr.Loder, of Moscow, thinks the disease is primi- 



296 CAUSES OF THE CHOLERA, 

tively nervous, and depends on an electro-magnetic 
cause. 

Dr. Hahneman, a distinguished German physician, 
asserts that the miasmata of cholera arises from very 
small insects, too minute to be seen, but which attach 
themselves to all parts of the body. But these last 
opinions are now but guesses at truth, if true they 
should prove to be, and are undeserving of attention 
so long as they are not supported by facts. 

3. A third, and probably an increasing class, are 
those who keep to a middle course, between the con- 
tagionists and the anti-contagionists, and believe in 
what is called the doctrine of contingent contagion. 
These say, that although the disease arises from some 
aerial or terrestrial influence, of which we at present 
know nothing, and over which we have no control, 
yet in the filthy hovels of the indigent, in the impure 
air of crowded apartments, the disease may, and 
sometimes does acquire a character of communica- 
bility, which it did not at first possess, and of which 
it is deprived, when these circumstances are not pres- 
ent, or when it occurs in well ventilated and cleanly 
situations. 

Let us now inquire which of these opinions are sup- 
ported by the most numerous and best authenticated 
facts. 

The exclusive contagionists, in support of their 
opinions, advance the following facts : — 

1. The disease was imported into Calcutta, and 
other places in Bengal, from Jessore, in 1817. 

2. It has always followed the great travelled routes, 
such as the large roads, navigable rivers, &c, and 
has been transported from one country to another by 
vessels, armies, and caravans. 



AND MEANS OF PREVENTION. 297 

3. The nurses and attendants in cholera hospitals 
have frequently been attacked by the disease. 

4. Several cities, fortresses, and private dwellings 
have established rigorous sanitory measures, and the 
cholera has not been manifested among them. 

5. Individuals coming from places where the dis- 
ease raged, have sickened of the cholera in a healthy 
town ; and soon after, several of their attendants have 
died of the same disease. 

6. The cholera was imported into Mauritius by the 
Topaze frigate, which sailed from Calcutta while the 
disease was raging there. 

7. The disease was imported into Orenburg, by 
caravans, from central Asia. 

8. It was brought to Dantzic, by a vessel from 
Riga, the captain of which ship, died the day of his 
arrival, and afterwards the disease spread to the 
town. 

9. The cholera was imported into Sunderland from 
Hamburgh, or from some of the ports on the conti- 
nent of Europe. 

10. It was brought into Canada by vessels and 
emigrants from Ireland. 

To these strong and striking facts, the Anti-conia- 
gionists reply, in general terms, that many of the 
facts alledged, will not bear investigation. That 
many of them are not true ; and that all can be ex- 
plained without resorting to the belief that the dis- 
ease is contagious. 

They say the inhabitants of every town, and coun- 
try, are exceedingly averse to admitting that a pesti- 
lential disease has originated among themselves, and 
are ever ready to lend a willing ear to tales of its im- 
portation, and easy credence to any facts that tend 



298 CAUSES OF THE CHOLERA, 

to sustain their opinions. That during the prevalence 
of any general epidemic, some facts will undoubtedly 
occur, which may be brought to support the conta- 
giousness of the disease, while the general course of 
the malady demonstrates that it is not so. This is 
strikingly true of the influenza as will hereafter be 
shown. 

But to the facts adduced by the contagionists, their 
opponents reply in detail : 

1. That it was not imported from Jessore into Cal- 
cutta and Bengal, as on full investigation it was 
proved by the most conclusive testimony, that it oc- 
curred nearly at the same time, in various parts of 
the province, between which there had been no im- 
mediate intercourse. Further, — in India, the conta- 
gious nature of cholera is denied by 99, out of every 
100 medical men in that part of tho world. {Dr. 
James Johnson, 

2. If it was true that the cholera has been restrict- 
ed to great roads and rivers, it might be accounted for 
from the fact that there, men collect in the largest 
masses, where they are most exposed to all the 
causes which the anti-contagionists say produce the 
disease, such as filth, intemperance, want of food, 
pure air, &c. &c. But the fact is doubted. Sur- 
geon Mitchell, in his report from Palmacottah, says, 
' as far as I can learn, the cholera appears to have 
made its approach by neither of the great roads. 
Commencing its ravages here, to the eastward, a lit- 
tle north of the fort, it spread pretty generally through 
the small, low, dirty houses, in every direction. The 
hospital seems to have escaped, probably because the 
building stood upon high and open ground.' 5 

But the following statement from Mr. Bell, author 



AND MEANS OF PREVENTION. 299 

of one of the best works on the cholera, and who 
served in India from 1818 to 1829, where he saw 
much of the disease under every possible aspect, is a 
triumphant argument against the exclusive contagion- 
ists: 

;i But it has been said to accompany troops, in 
marching into a district where it had not previously 
prevailed, and into which it has thus been introduced. 
This statement is so much at variance with the well 
ascertained habits of the disease, that it would re- 
quire the most minute inquiry, and unquestionable 
evidence, to entitle it to credit. It has been repeatedly 
ascertained, that cholera patients may be carried 
into hospitals crowded with patients laboring under 
other diseases, without these, or numerous hospital 
attendants, having the disease communicated to 
them. Yet it is asserted, that a regiment, travelling 
at the rate of six or ten miles a day, has carried the 
disease along with it a hundred miles or more, com- 
municating it to the inhabitants as it passed on ! We 
have seen that a camp, by shifting ground a short dis- 
tance, has put a stop to the ravages of the disease. 
And is it to be believed, that a regiment cannot get 
rid of it, with no cause but contagion for its continu- 
ance, by ten or twenty marches ? 1 conceive, that 
this supposed proof of a contagious quality in cholera 
may be otherwise accounted for. When travelling 
on circuit, I have found the disease prevailing in a dis- 
trict, before any report had been made of the fact, not- 
withstanding the most positive orders on the subject ; 
and 1 am persuaded, that were any of the instances 
adduced in support of the statement under consider- 
ation, strictly inquired into, it would be found that the 
usual apathy of the natives of India had prevented 



300 CAUSES OF THE CHOLERA, 

their noticing the existence of the disease, until the 
fact was brought prominently forward by the pre- 
sence of Europeans. It should also be borne in 
mind, that cholera asphyxia is not a new disease to 
these natives; but seems to be in many places almost 
endemical ; whilst it is well known, that strangers, in 
such circumstances, become more obnoxious to the 
disease than the inhabitants of the country. More- 
over, travellers have, superadded to the remote causes 
of the disease, fatigue and road discomforts, which 
are not trifling in a country where there are neither 
inns nor carriages. 

The following extract from the Journal of my first 
journey in India, is illustrative of some of the peculi- 
arities, in this disease, to which I have adverted. In 
July 1819 1 marched from Madras in medical charge 
of a large party of young officers, who had just 
arrived in India, and who were on their way to join 
regiments in the interior of the country. There was 
also a detachment of Sepoys, and the usual numer- 
ous attendants and camp-followers of such a party in 
India. 

The cholera prevailed at Madras when we left it. 
Until the fifth day's march, (50 miles from Madras,) 
no cases of the disease occurred. On that day seve- 
ral of the party were attacked on the line of march ; 
and, during the next three stages, we continued to 
have additional cases. Cholera prevailed in the 
country through which we were passing. In consul- 
tation with the commanding officer of the detach- 
ment, it was determined that we should endeavor to 
leave the disease behind us ^ and as we were informed 
that the country beyond the Ghauts was free of it, 
marched without a halt, until we reached the high 



AND MEANS OF PREVENTION. 301 

table land of Mysore. The consequence was, that 
we left the disease at Vellore, 87 miles from Madras, 
and we had none of it until we had marched 70 miles 
farther, (7 stages,) when we again found it at one of 
our appointed places of encampment- But our camp 
was, in consequence, pushed on a few miles, and only 
one case, a fatal one, occurred in the detachment. 
The man was attacked on the line of march. We 
again left the disease, and were free from it during 
the next 115 miles of travelling. We then had it 
during three stages, and found many villages desert- 
ed. We once more left it, and reached our journey's 
£nd, 260 miles farther, without again meeting it. 
Thus, in a journey of 560 miles, this detachment was 
exposed to, and left the disease behind it, four differ- 
ent times 5 and on none of those occasions did a 
single case occur beyond the tainted spots." 

3. That some of the attendants on cholera patients 
have been attacked by the disease is undoubtedly 
true, yet facts from all countries where the disease 
has prevailed, abundantly exhibit that they are no 
more liable to the disease than other classes in the 
same community, who are engaged in laborious em- 
ployments. Reports from India, Russia, Poland, 
England, France, Canada and New York, all con- 
cur in the fact of the remarkable exemption of the at- 
tendants upon cholera patients. The proof of this 
statement will be found in another part of this work. 

4. That some cities and fortresses which establish- 
ed rigorous quarantine regulations, have escaped the 
disease, is very true •, but it is also true, that other 
places immediately adjoining those which were at- 
tacked, have escaped, notwithstanding every precau- 

26 



302 CAUSES OF THE CHOLERA, 

tionary measure had been omitted. Jt is further true 
that numerous countries, cities, and fortresses have 
adopted and enforced the most severe preventive regu- 
lations ; they adopted them early, and executed them 
with rigor, and yet the disease appeared among them. 
AH that quarantine enactments can do towards pre- 
venting the spread of a disease from one country to 
another has been done in Russia, Austria and Prussia. 
In Russia immense lines of troops were formed for 
arresting its progress : St. Petersburg was entirely 
surrounded by cordons sanitaires \ but all these regu- 
lations enforced by a powerful and despotic govern- 
ment were unable to prevent the approach and the 
spread of the cholera throughout the Russian Em- 
pire. The efforts of Austria were equally unavailing, 
for in a short time the disease passed her triple cor- 
dons and invaded the country from Poland. Prussia 
employed sixty thousand of her best troops to en- 
force her rigorous restrictions, and travellers bear tes- 
timony to the severity with which they were enforced. 
"And what have been the results ? An immense ex- 
penditure of money, the suspension of commerce, a 
stop put to industry, multitudes deprived of the means 
of acquiring subsistence, and whole families plunged 
into misery, and rendered favorable subjects for the 
disease ; but no stop to the extension of the disease, on 
the contrary its progress was rendered more fatal. 
As an instance of this, Breslau may serve as an illus- 
tration ; and a warning to other cities. That city con- 
tains 90,000 inhabitants, active, commercial and in- 
dustrious, many of them manufacturers and artisans. 
A quarantine of twenty days, with difficulties almost 
insurmountable which it entailed, was established at 
the borders of the province and maintained with a ri- 






AND MEANS OF PREVENTION. 303 

gor, which might serve as a model to other nations. But in 
the midst of this apparent security, a woman living in 
a damp part of the town was attacked by the cholera, 
and in a few days the disease spread. The most 
minute researches on the part oj the public authorities 
could not discover any communication between this wo' 
man and any stranger or goods suspected of being in- 
jected. But when the disease spread, the authorities 
saw too late the deep injury which their sanitary 
measures had inflicted ; a multitude of families, and 
thousands of individuals were plunged in extreme 
misery, for the sudden cessation of commerce, and 
consequent suspension of labor, had deprived them of 
the means of subsistence"* 

Taught by sad and lamentable experience, Russia, 
and Austria, and Prussia have withdrawn their cor- 
dons and acknowledge not only their inutility, but 
that they are productive of immense evils. Indeed 
all the nations of Europe are abandoning severe 
quarantine regulations^ and it is hoped that the cities 
of this country will not adopt them, but place all 
their reliance for the prevention of the disease, on the 
removal of those causes which in all countries have 
appeared to produce it 

5. Individuals coming from infected districts, and 
becoming sick with the cholera in a town where the 
disease had not before prevailed ; appear to have 
communicated the disease to their attendants, who 
have soon sickened and died. Such instances are 
not numerous though they have been witnessed in all 
countries. Thus the Bombay report says, that a 
man left Pan well, whilst the disease prevailed there, 
arrived at Bombay and was attacked and died ; the 

* American Journal of Medical Sciences, May 1832. 



304 CAUSES OF THE CHOLERA, 

next day his wife, and the wife of the man who lived 
next door, and soon several of the neighbors died of 
the same disease. 

Scouttetten, relates the following instance. An 
European left Madras, where the cholera existed in 
Oct. 1818; fell sick on his journey and died at St 
Thomas-du-Mont, where the disease had not appear- 
ed. The next day his wife died ; two days after- 
wards the landlord perished, and in two days more 
the landlady and domestics were attacked. Several 
cases of a similar kind are furnished by the Russian 
official documents. In this country we have had a 
few similar cases. Thus a woman and child, from 
New York, where the disease prevailed, arrived at 
New Haven, Con. in the steam boat ; they were ex- 
posed to the wet on landing and fatigue by walking. 
They both sickened ; and were reported by the phy- 
sician who attended them to the Board of Health as 
cases of Asiatic cholera, of a mild character. These 
two cases recovered. But soon after the parents of 
the woman that had recovered, and who were intem- 
perate persons, sickened and died of the disease. It 
is said the family were in a destitute and filthy condi- 
tion. 

Cases of the same character and accompanied by 
like circumstances occurred at Hartford, in the same 
state. A colored man went from Hartford to New 
York while the disease prevailed there. He com- 
plained of ill health before he left Hartford, and on 
his return from New York was attacked by diar- 
rhoea which continued several days, and greatly re- 
duced him. July 20th he took castor oil which re- 
duced him still more and increased his diarrhoea. 
The afternoon of the same day, he was attacked by 



AND MEANS OF PREVENTION. 305 

vomiting of a light colored fluid resembling rice wa- 
ter, and the discharges from the bowels were of the 
same character. He had cramps of the extremities 
and other symptoms which induced his attending phy- 
sicians to report the case to the Board of Health as 
one of Asiatic cholera of a mild character. This 
man recovered, but his parents, said to have been in- 
temperate, and who had attended upon their son, 
had lodged in the same room, and had been deprived 
of their usual rest, and who immediately took cath- 
artic medicines : sickened two days after the attack 
of the son, and both died, with the symptoms of cho- 
lera. 

Instances like these, though they are not numerous, 
have convinced many of the contagious nature of the 
disease. But do facts warrant this conclusion ? Are 
we bound to believe, from the facts presented, that 
these cases were produced by some specific poison 
brought from New- York, and emanating from the 
body of the sick person, affected those that were well ? 
Were none of the causes present which in every oth- 
er country, have, in alliance with the general epi- 
demic influence, sufficed to produce the disease, or 
are they in these cases to be deemed inoperative, and 
to pass for nothing ? Is the natural anxiety of pa- 
rents, — intemperance, night-watching, the terror ari- 
sing from the assurance that the first case was Asiat- 
ic and malignant cholera, brought from a place wheie 
it was daily destroying great numbers, — the injudi- 
cious use of cathartic and preventive medicines, ac- 
cumulated filth, crowded, ill ventilated rooms, to be 
considered wholly inert in producing the disease 
in Connecticut, although all these causes existed 
26* 



306 CAUSES OF THE CHOLERA, 

there, and are the very causes that we are assured by 
medical men, and by the evidence of innumerable 
facts, have served to produce the disease in all other 
countries ? 

The medical authorities of Orenburg, of Dantzic, 
of Moscow, of St. Petersburg, of Sunderland, of 
Quebec and Montreal, of New- York and Philadel- 
phia, and most other places where the disease has 
prevailed, have stated that it was impossible to trace 
its introduction from abroad into any of these places, 
but that the disease developed itself spontaneously in 
all of them. 

In reply to the arguments in favor of contagion, 
derived from the cases at New-Haven, Hartford, &c. 
the anti-contagionists say, that other cases of a more 
malignant character have been witnessed in different 
parts of the country, and yet none of the attendants 
on these fatal cases have had the disease. Is a mild 
case of cholera more likely to be contagious than a 
severe and fatal one ? A man from New-York died 
of cholera on board of a steam-boat at Hartford. 
Many individuals attended upon him, and the crew 
of the boat, consisting of more than 20 persons, were 
exposed. They took care of him when sick, and as- 
sisted in burying him, and were confined on board 
the same boat for several days, and yet not a single 
individual has been affected by the disease. 

A man left New-York when the disease prevailed 
there ; sickened and died of the cholera at Brook- 
field, Mass. Not one of his attendants have had the 
disease. 

But the occurrence of the cholera at Providence, 
R. I. affords, say the anti-contagionists, a triumphant 



AND MEANS OF PREVENTION. 307 

reply to the arguments of the contagionists, and is in 
accordance with the general facts respecting the oc- 
currence of the cholera inmost of the places where 
it has appeared. 

All the facts connected with the first appearance of 
this disease at Providence, are so important, that I 
shall insert the whole of the Report of the Special 
Medical Council of the Board of Health. 

Report. — "It has become our painful duty to an- 
nounce to the public, the occurrence of four cases of 
epidemic cholera, in this city. 

The following is a brief statement of the most im- 
portant facts relative thereto, viz. 

John Thurber, (aged about 50,) the first individual 
attacked, has enjoyed unusually good health, for some 
time past, until Wednesday, July 25th, when he was 
seized, (as persons often are, in summer,) with vomit- 
ing and purging, which the family endeavored to com- 
bat until Monday morning, when their efforts not 
proving successful, Dr. Utley was sent for, who, by 
the use of ordinary means, succeeded in relieving the 
patient ; he afterwards appeared to be in a fair way 
to recover, until last evening, (July 31st,) when, as 
was supposed, from the mental excitement produced, 
by hearing of his wife's seizure, he relapsed, and was 
also attacked with violent spasms of the hands and 
feet, which have continued in a milder form to this 
time ; but from the presence of other symptoms, his 
situation now is extremely critical. 

The second individual taken sick was Mrs. Thur- 
ber, as above noted. She first complained yesterday 
forenoon of a slight uneasiness in the bowels ; this, 
however, did not attract particular attention. About 



308 CAUSES OF THE CHOLERA, 

3 o'clock, P. M. she was seized with violent vomit- 
ing, purging, and cramps, that continued at intervals 
until a few hours previous to her death, which took 
place at 7 o'clock this morning. 

The third patient was a young girl by the name of 
Slocum, aged 3| years. She went to school, appa- 
rently in perfect health, yesterday afternoon. At a 
quarter before 5, she complained to the instructress 
of feeling sick, and was in consequence sent home. 
Soon after reaching home, vomiting and purging set 
in, which were shortly followed, according to her 
mother's account, by coldness of the surface, and a 
cessation of the pulse at the wrist. The usual symp- 
toms noticed in this disease shortly ensued, and con- 
tinued to increase until her decease, which happened 
at three o'clock this morning. 

The fourth case is a sister of the preceding one, 
aged 5 ; she first began to complain about half past 
3 this morning, with pain in the bowels ; which was 
soon aggravated and followed by the symptoms al- 
ready alluded to ; she is now in a state of collapse. 

The attending physician thought it advisable to call 
in, in the course of the night, (of the 31st July) the 
following gentlemen in consultation, viz : — Doctors 
Fuller, Mauran, Miller, Webb and Hartshorn ; who, 
after a careful examination of the patients, gave it 
unanimously as their opinion, that they labored un- 
der the same disease as has extensively prevailed in 
New- York, and elsewhere. 

At the time of the consultation, Mrs. Thurber was 
in a confirmed state of collapse ; there were the pe- 
culiar appearance of the countenance, the change of 
voice, coldness of the tongue and breath, impercepti- 



AND MEANS OF PREVENTION. 309 

bility of the pulse, corrugated appearance of the 
hands, &c. 

Post mortem examinations were made of the two 
deceased patients, in the presence of a large majority 
of the medical faculty. The appearances presented 
were such as to convince all of the correctness of the 
opinion previously formed of the cases, and corres- 
ponded precisely with what had been witnessed in 
New- York by several of the physicians. 

All of these cases occured in the same house, 
which is situated in Field Street, on Eddy^s Point, on - 
the west side of the river, and its location, as far as 
we are enabled to judge, is a healthy one. 

Upon enquiring, we were informed that there had 
been no communication between the inmates of the 
house, and any individual from New-York, or other 
places where the cholera prevails, or has prevailed. 
Mr. Thurber and wife resided in New- York, with 
their son-in-law, until the 11th of June, when they 
removed to this place, and have, previous to the at- 
tack now described, enjoyed their usual health. The 
date of their quitting the city of New- York, was 
three weeks previous to the official announcement of 
the cholera in that place, and two days subsequent to 
its first appearance on this continent. 

The preceding brief account is respectfully submit- 
ted for the information of the public, by order, and in 
behalf of the medical gentlemen of this city. 

LEWIS L. MILLER, 
LEANDER UTLEY, 
THOMAS H. WEBB, 
ISAAC HARTSHORN 

Providence, Aug. \,one d* clock, P. MP 



310 CAUSES OF THE CHOLERA, 

The above facts are very deserving of considera- j 
tion. The first case appears to have been like ordi- 
nary seizures of vomiting and purging, and yielded 
to ordinary treatment, until the mental excitement 
produced by the seizure of his wife aggravated 
all his symptoms, and produced a relapse of 
which he died. It serves to show the close connec- 
tion between the common cholera of our country, 
and what is called Asiatic cholera, and how easily 
fear, and other causes may transform the one into the 
other. The influence of fear in producing and ag- 
gravating the cholera, has been acknowledged by al- 
most all writers upon the disease, but its influence, it 
appears to me, has been underrated and misunder- 
stood ; I shall therefore recur to it in another place. 

6. It has been said the cholera was imported 
into Mauritius, by the Topaze frigate, from Ceylon. 
To this, it is replied, that Dr. John Kinnis, who resi- 
ded at Mauritius, and had charge of a hospital there, 
in a report addressed to Sir James M'Grigor, and 
published in the Edinburgh Medical and Surgical 
Journal for 1821, says, that 2 cases of the disease oc- 
curred 3 weeks before the arrival of the Topaze, and 
when the vessel did arrive, the surgeon of the frigate 
stated, that not one of the crew were affected by the 
cholera ; and Dr. K. from personal observation, as- 
sures us that not one of the patients sent from the 
Topaze to the hospital, labored under symptoms of 
cholera ; and further, that the disease did not break 
out among the attendants on these men, but among 
the African slaves and Indian convicts. 

The disease soon run its course in this island, and 
then appeared at Bourbon, in defiance of a most rig- 
orous quarantine. 






AND MEANS OF PREVENTION. 31 { 

7. The disease was imported into Orenburg, say 
the contagionists, by caravans from Asia. To this 
their opponents reply, that the last caravan that arri- 
ved at Orenburg, reached that place thirty-five days 
before the first case of cholera appeared, and that 
the individuals composing it, were all in good health, 
and had not imparted the disease to any of the fron- 
tier towns through which they had passed. 

3. It was brought to Dantzic by a vessel from Ri- 
ga, it has been said. But Dr. Dalmas, a member of 
the Medical Commission, sent by the French Govern- 
ment to Warsaw 7 , investigated the subject himself at 
Riga ; and states, as the result of his investigations, 
the following facts, which have not been denied. 

1 . That the cholera did not exist at Riga, at the 
time of the sailing of the vessel mentioned. 2. That 
the cholera did not appear on board the ship du- 
ring the voyage. 3. That the cholera appeared 
at Dantzic before the arrival of the vessel ; that 
it broke out in the town before it appeared at the 
port ; and lastly, the cordon sanitaire did not protect 
the neighboring places. These assertions Dr. D. 
supports by proofs, too abundant to detail. 

9. The advocates of contagion say, the chole- 
ra was imported into Sunderland by vessels from 
Hamburgh, or from some port in the north of Europe. 
Such an origin of the complaint at Sunderland, was 
widely circulated in the newspapers ; but on investi- 
gation, it has proved to be wholly without foundation. 
The disease first manifested itself in a part of the 
town more than two miles distant from where the 
vessels were lying, and among those who had no 
communication with the port. Besides, both Dr. 
Bvown, and Dr. White, of Sunderland, state, that the 



312 CAUSES OF THE CHOLERA, 

same disease, accompanied by all the symptoms as- 
cribed by observers to the Asiatic cholera, prevailed 
there in August, two months before the arrival of the 
vessels that are charged with having brought the dis- 
ease from the continent 

10. Again, it is said, the cholera was imported 
into Canada by vessels and emigrants from Ire- 
land. The board of health at Quebec are in pos- 
session of no facts calculated to show that the disease 
was imported into that city, and the most eminent phy- 
sicians of Montreal, and the most enlightened citizens 
in that city are satisfied that it is an epidemic, and 
not a contagious disease. They say that many cases 
of cholera occurred six weeks before the vessel and 
emigrants arrived. 

I have thus given some of the most important facts 
produced in justification of their belief, by those who 
say that the epidemic cholera which now prevails in 
this country, and many l other parts of the world, is a 
contagious disease. I have also given what many of 
their opponents upon this subject, call a complete re- 
futation of them. And upon a review of all the facts 
and arguments which have been adduced by both 
parties, upon this difficult subject, surely, the consci- 
entious enquirer after truth, will be oliged to confess 
that if the cholera is at all, or under any circumstan- 
ces a contagious disease, it is so but in a trifling de- 
gree, and that generally, it is propagated by other 
means than by the transmission of some poisonous 
substance from the diseased to the healthy. 

The anti-contagionists say, the cholera has al- 
ways been an endemic disease in India, but that in 
1817 it assumed an epidemic character. The cause 
which produced thischaracter, like the origin of most 



AND MEANS OF PREVENTION. 313 

general pestilences, is still a mystery. Probably, 
however, it is some atmospheric phenomenon. Mr. 
Scott, Dr. Jameson, and Mr. Annesley, say that the 
seasons preceding the appearance of the epidemic in 
India, were remarkable for atmospheric vicissitudes, 
and the disease appeared at the commencement of a 
rainy season, so excessive as to convert the whole 
delta of the Ganges into a sheet of water. 

But what that epidemic influence is, which has 
made cholera prevail so extensively since then, and 
diffused it over the world, we do not know, any more 
than we know the cause of any epidemic. We do, 
however, know that there are predisposing and exci- 
ting causes, which, if avoided, even when the gene- 
ral epidemic influence prevails, will, for the most part, 
serve to protect people from the cholera, or transform 
the disease from a highly malignant and incurable dis- 
order, into a mild one, over which medicines have 
great control. 

These causes so necessary to be known, and to be 
avoided, are exposure to cold and moisture, or sudden 
changes from heat to cold, a scanty, poor, or bad di- 
et, lodging in crowded, damp, or ill-ventilated rooms, 
or upon the ground, fear and mental anxiety, accumu- 
lations of filth among a crowded population, excesses 
of all kinds, especially intemperance in the use of 
stimulating drinks, &c. &c. &c. 

These causes have ever been sufficient to produce 
sporadic cases of cholera, in all countries, and when 
more powerful, they may cause the disease to be 
epidemic. If it is asked why these causes have never 
before produced the disease in the United States, we 
reply by asking, why it did not appear at Jessore in 

1800, or in 1820, or some other time, instead of 1817, 

27 



314 CAUSES OF THE CHOLERA, 

All we can infer from the facts given us respecting 
the disease, is, that exactly the same causes could nev- 
er have been in operation before, in either place. In 
proof that the causes assigned, serve to produce and 
aggravate the disease, we are told they were all in ope- 
ration in the towns of India, when the disease prevailed. 
The population in most parts of India, is very dense, 
and in the large towns, exceedingly so. The following 
account of Calcutta, from the correspondence of the 
lamented Bishop Heber, is applicable to most of the 
cities and towns in India : — 

" Calcutta, Dec. 15, 1823. 
Of the country, we have as yet seen little, except 
in one voyage up the river, and in the vicinity of Cal- 
cutta. But all Bengal is described to us as like those 
parts which we have seen, a vast alluvial plain, inter- 
sected by the innumerable arms of the Ganges, over- 
flowed once a year, but now covered with fields of 
rice, divided by groves of tall fruit-trees, with villages 
under their shelter, swarming with a population be- 
yond any thing which Europe can show, and scarcely 
to be paralleled in China. Calcutta, when seen from 
the south, on which side it is built round two sides of 
a great open plain, with the Ganges on the west, is a 
very noble city, with tall and stately houses, ornament- 
ed with Grecian pillars, and each, for the most part, 
surrounded by a little apology for a garden. The 
churches are not large, but very neat, and even elegant 
buildings, and the government house is, to say the 
least of it, a more showy palace than London has to 
produce. These are, however, the jront lines ; be- 
hind them ranges the native town, deep, black, and 
dingy, with narrow crooked streets, huts of earth ba- 
ked in the sun, or of twisted bamboos, interspersed 



AND MEANS OF PREVENTION. 315 

here and there with ruinous brick bazars, pools of 
dirty water, coco-trees, and little gardens, and a few 
very large, very fine, and generally very dirty houses, 
of Grecian architecture, the residence of wealthy na- 
tives. There are some mosques of pretty architect- 
ure, very neatly kept 3 and some pagodas, but mostly ru- 
inous and decayed, the religion of the people being 
chiefly conspicuous in their worship of the Ganges, 
and in some ugly painted wooden or plaster idols, with 
all manner of heads and arms, which are setup in dif- 
ferent parts of the city. Fill up this outline with a 
crowd of people in the streets, beyond any thing to 
be seen even in London ; some dressed in tawdry silks 
and brocades, more in white cotton garments, and most 
of all black and naked, except a scanty covering round 
the waist, besides figures of religious mendicants, with 
no clothing but their long hair and beards in elf locks, 
their faces painted white or yellow, their beads in one 
ghastly lean hand, and the other stretched out like a 
bird's claw to receive donations ; marriage processions, 
with the bride in a covered chair, and the bridegroom 
on horseback, so swathed round with garlands as hard- 
ly to be seen ; tradesmen sitting on the ground in the 
midst of their different commodities, and old men, 
lookers on, perched naked as monkeys on the flat roofs 
of the houses; carts drawn by oxen, and driven by 
wild looking men, with thick sticks, so unmercifully 
used as to undeceive perfectly all our notions of Brah- 
minical humanity; attendants with silver maces, pres- 
sing through the crowd before the carriage of some 
great man or other; no women seen, except of 
the lowest class, and even these with heavy silver or- 
naments on their dusky arms and ankles ; while coach- 
es, covered up close with red cloth, are seen convey- 



316 CAUSES OF THE CHOLERA, 

ing the inmates of the neighboring seraglios to take 
what is called the i air ;' a constant creaking of cart 
wheels, which are never greased in India ; a constant 
clamor of voices, and an almost constant thumping 
and jingling of drums, cymbals, &c., in honor of some 
of their deities ; and add to all this a villainous smell 
of garlic, rancid coco-nut oil, sour butter, and stag- 
nant ditches, and you will understand the sounds, 
sights, and smells of what is called the ' Black Town* 
of Calcutta. 

The singularity of this spectacle is best, and least 
offensively enjoyed on a noble quay which Lord Has- 
tings built along the shore of the river, where the ves- 
sels of all forms and sizes, Arab, Indian, Malay, Amer- 
ican, English, the crowds of Brahmins and other Hin- 
doos washing, and saying their prayers ; the lighted 
tapers which, towards sun-set, they throw in, and the 
broad, bright stream which sweeps them by, guiltless 
of their impiety, and unconscious of their homage, af- 
ford a scene such as no European, and few Asiatic cit- 
ies, can at all parallel in interest and singularity ." 

Mr. Kennedy, in his history of the cholera, says, it 
w 7 as amongst the swarming population of these filthy 
receptacles, who barely subsisted on a meagre diet of 
bad rice, who worked hard in the sun during the day, 
and who lodged in their small mud hovels, and not un- 
frequently with cows and other animals, that the chol- 
era run a long and wide career of destruction. 

Dr. Young, in his remarks upon the cholera morbus, 
as it prevailed in the villages around Calcutta, says, 
there are in the lowest and most thickly inhabited quar- 
ters, many ditches of stagnant, filthy water, on the 
margins of which, the natives sleep, during the hot and 



AND MEANS OF PREVENTION: 317 

sultry nights. In such situations, he says, the cholera 
raged with double and dreadful fury, while the dryer, 
better drained, and more thinly inhabited parts of the 
town, suffered comparatively but little, 

Every wliere, the disease has not only been most se- 
vere in crowded, dirty towns, but has generally been 
confined to those parts of towns that are most so, and 
that are inhabited by the poor and suffering portion of 
the population. 

For instance, the merchants of the town of Gun- 
toor, who occupy spacious dwellings, in a wide, dry 
street, almost entirely escaped the disease, which ra- 
ged with great violence among the people who resided 
in the close damp alleys of the town. 

Multra, a filthy place, containing many dirty and 
crowded bazars, suffered severely, whilst Argra, a clean 
airy town, almost entirely escaped. 

In Tripoli, a very clean town in Syria, only thirty- 
one were attacked, and five died, out of a population 
of 15,000, and the disease disappeared in a few days ; 
whilst at Antioch, and other low and badly ventilated 
places, it prevailed for a long time, and raged with 
great violence. 

The disease has, in all countries, manifested the like 
partiality for the most dirty and crowded cities ; and 
for low and damp situations. 

The following interesting observations on the statis- 
tics of Sunderland, from the work of Mr. Parsons, as 
published in a late number of the Medico Chirurgical 
Review, fully confirm the above statement : — 

' The town of Sunderland consists of three parishes ; 
viz. Monk Wearmouth, with a population of about 
6,000, — Bishop Wearmouth, with 14,000, — and 

Sunderland with 20,000 inhabitants. In Bishop 

27* 



318 CAUSES OF THE CHOLERA, 

Wearmouth nearly all the wealthy inhabitants of the 
town reside, and the number of its pauper popula- 
tion is very small ; the streets are generally sufficient- 
ly wide and clean, and their elevation above the le- 
vel of the river is from 110 to 120 feet. In Sunder- 
land, which is a continuation of Bishop Wearmouth, 
there are very few streets of proper width, and their 
general elevation above the level of the river is from 
70 to 90 feet lower than in the adjoining parish. The 
bye-streets are extremely narrow, several not being 
broad enough for the passage of a common cart, and 
during my residence in the town they were rarely 
cleansed from the dirt, and other impurities allowed 
to accumulate in them, for many days together. The 
houses in these bye-streets or lanes commonly had no 
yards or courts attached to them ; the rooms w T ere 
dark, ill ventilated and dirty ; the passages and stairs 
were dirty through the great number of persons living 
in each house ; and very often each room, from the 
cellars to the attics, was occupied by a whole family ; 
Dr. Barry found 120 individuals living in one of these 
houses. In the parts bordering on the river, Monk 
Wearmouth closely resembles Sunderland in the 
crowded state of its poor inhabitants. For several 
years past it has been the custom in Sunderland for 
the parish managers to contract with some individual 
for the maintenance, &c. of the whole poor of the 
parish. When this plan was first adopted, now about 
seven years since, the annual expense for t hi spur- 
pose amounted to upwards of 9000/., the number of 
persons contributing to the poor-rates being at that 
time, as it is at present, rather more than five hun- 
dred, and consisting almost entirely of the shop-keep- 
ers and others necessarily resident in the place ; but, 



AND MEANS OF PREVENTION. 319 

by means of the farming system, the annual expense 
has been gradually reduced to its amount in the pre- 
sent year, of between three and four thousand pounds, 
with, it is believed, a considerably increased number 
of claimants on the parochial funds. A necessary 
consequence of this cruel economy, was the state of 
great destitution in which the poor existed at the time 
of the appearance of cholera amongst them ; and, 
although much was done towards improving their 
condition, by giving them clothes, bedding, fuel, &c, 
still it was found that individual exertions were man- 
ifestly unequal to counteract the ill effects, on the 
public health, of extreme and widely diffused poverty, 
and its too frequent consequences, a neglect of clean- 
liness, drunkenness from the immoderate use of ar- 
dent spirits, and the gratification of other depraved 
propensities. The death, by cholera, of Mr. Middle- 
brook, the late contractor for the poor, has released 
the parish from its engagement to him, and the sys- 
tem of farming the paupers is now, though late, abol- 
ished.' 

The ravages of the disease were chiefly confined 
to the parish of Sunderland ; in Bishop Wearmouth, 
which contains at least one-fifth of the whole popula- 
tion, but only a small portion of the pauper inhabi- 
tants of the town, a few cases occurred in the middle 
of November, and again in the beginning of Decem- 
ber ; but up to the 12th of that month the number of 
deaths in this parish did not exceed 20. In the pa- 
rish of Monk Wearmouth but few cases occurred, 
not more than 15 deaths having taking place from 
the disease up to the same date. 

With regard to the parish of Sunderland itself, the 
disease was almost exclusively confined to the low, 



320 CAUSES OF THE CHOLERA, 

dirty, and confined lanes in thickly populated dis- 
tricts, not more than 12 cases having occurred in the 
upper and more widely-built portion, although the 
freest and most unrestrained communication existed 
with those places where the disease raged. 1 " 

From the accounts which we have received from 
Quebec, Montreal, New York and other places 
where the cholera has appeared on this continent, 
we learn, that it has manifested the same tendency to 
prevail mostly in confined, low and dirty streets, 
where the population is crowded, and suffering for 
want of food, clothing, pure air, &c. &c. 

But as 1 have said, there is another class of medi- 
cal men who are neither contagionists, nor fully anti- 
contagionists, but who believe in the doctrine of con- 
tingent contagion. 

They say that the cholera has for its essential and 
general cause some serial or terrestrial influence, the 
nature of which we know nothing ; but that in gene- 
ral this influence will not produce severe cholera un- 
less aided by other causes, such as exposure to cold, 
want of proper food, and clothing, and pure air ; or 
by intemperance, debauchery, &c. &c. In this 
way they believe the disease is generally propagated, 
but still they say, there are facts too numerous to be 
disregarded, or to be explained in any way, but by 
admitting that under certain circumstances, such as 
concentrated filth, bad air, and crowded rooms where 
the sick are confined, the disease may and does as- 
sume a contagious character, although it is not so es- 
sentially or generally. This party are however stren- 
uous opposers of quarantine and other regulations, 



AND MEANS OF PREVENTION. 321 

of a rigid character, which have been imposed upon 
towns and countries, and which the whole progress 
of the disease has shown to have been of no utility 
whatever. The only practical use of this doctrine 
which its advocates wish to make, is a very desirable 
one, — to thoroughly cleanse the apartments of the 
sick, and remove from the same all individuals except 
necessary attendants. When this course is pursued 
they do not believe the disease possesses the charac- 
ter of communicability. 

Among the innumerable facts, which they, in com- 
mon with the anti-contagionists, adduce in justifica- 
tion of their disbelief in the contagious nature of 
cholera, the following, are but a very small part. 

1 . That the cholera is not a contagious disease, but 
arises from some atmospheric distemperature, is evi- 
dent from the fact that its appearance in a place is 
usually preceded by sporadic cases of cholera, and 
the general prevalence of disordered digestion ; and 
when the disease does appear as an epidemic, scarce- 
ly a single individual in the same town escapes 
having some disorder of the stomach and bowels. 
Almost every individual complains of diarrhoea. This 
statement is confirmed by all the accounts we have 
received from India, Russia, Poland, England and 
France, and ii has been noticed in all the places 
where the cholera has prevailed in this country. The 
fact is so well known, that reference to authorities is 
unnecessary. 

2. This atmospheric distemperature is, in many 
places, so powerful as to affect animals. Cattle and 
dogs died of cholera in India, goats and camels in 
Persia, chickens, turkeys, &c. in Moscow, and in 
Prussia, multitudes of fish died during the prevalence 
of the epidemic. 



322 CAUSES OF THE CHOLERA, 

3. The sudden invasion of the disease, or the small 
space of time that elapses between perfect health and 
the full development of the disease, is very different 
from the slow progress of contagious diseases. At 
Bellamy in India, a tailor was attacked while at work, 
and died with his work in his hands, in the attitude 
in which he was sitting. A merchant while making 
a bargain was seized, vomited twice, and instantly ex- 
pired. At Mecca, the invasion of the disease was 
almost instantaneous ; individuals in perfect health 
were suddenly stricken to the earth, vomited, became 
cold, and died.— American Jour. Med. Sciences, 1 832. 
These are, to be sure, rare instances, as the disease 
does not usually terminate fatally in less than from 
six to twenty hours, and not unfrequently it lasts se- 
veral days. 

4. The great numbers attacked simultaneously by- 
cholera, and who had previously no intercourse with 
the sick, a fact which all writers on the disease admit, 
cannot be accounted for without supposing the disease 
to be epidemic. 

5. The general exemption from the disease of me- 
dical and other attendants on the sick, goes to prove 
that the disease is not propagated from the sick to the 
healthy. 

6. Dr. Jameson says, that of between 250 and 
300 medical men engaged in practice in Bengal, but 
three took the disease. 

7. At Bombay, none of the hospital attendants 
were attacked, though they were assisting the pa- 
tients day and night. Kennedy. 

3. The Madras Report says, in the hospital of the 
Royals' only one individual out of 101 attendants was 
attacked ; and at the receiving hospitals for cholera 



AND MEANS OF PREVENTION. 328 

patients at Trichinopoly, St. Thomas du Mount and 
Madras, the attendants were numerous, and some- 
times shared the same bed with their patients, yet not 
one took the disease. 

9. At Berhampore none of the native attendants on 
the cholera hospitals were affected. Trans. Med, 
fy Phys. Soc. of Calcutta. 

In Europe the same general immunity of the atten- 
dants on cholera patients has been witnessed. 

10. A letter addressed to the medical council of 
Moscow, signed by eight chief physicians to the hos- 
pitals of Astrachan, says, 

" We have all without any precaution touched and 
rubbed the sick. We have daily visited the hospitals 
crowded with cholera patients, where we have respi- 
red their breath, and yet we have neither contracted 
the disease nor conveyed it to our families. The at- 
tendants who nursed and applied frictions to the pa- 
tients — who put them into the baths, changed their 
linen, and performed other offices for the sick, remain- 
ed free from cholera." 

1 1 . The same letter adds, " In the military, as well 
as in the civil hospital, the linen and clothes of chole- 
ra patients, were transferred to other patients without 
being previously fumigated or ventilated, and never- 
theless, those who wore these garments did not become 
affected with cholera." The same letter also states 
that " Several nurses and mothers affected with chole- 
ra, suckled their children, both during and after the 
disease, without the latter being attacked with chole- 
ra." 

12. Dr. Lefevre, physician to the British embassy 
at St. Petersburgh, reports as follows : — 

u I knew four sisters watch anxiously over a fifth. 



324 CAUSES OF THE CHOLERA, 

severely attacked with the cholera, and yet received 
no injury from their care. 

" In one case, 1 attended a carpenter in a large 
room, where there were at least thirty men, who 
slept on the floor among shavings ; and though it was 
a severe and fatal case, no other instance occurred 
among his companions. 

" In private practice, among those in easy circum- 
stances, I have known the wife attend the husband, 
the husband attend the wife, parents their children, 
children their parents, and in fatal cases, where from 
long attendance and anxiety of mind, we might con- 
ceive the influence of predisposition to operate, in no 
instance have 1 found the disease communicated to 
the attendants." 

13. During the prevalence of the epidemic at Mos- 
cow, 587 patients affected with cholera were admitted 
into a hospital with 860 patients, laboring under other 
diseases, yet, not a single one of the latter became af- 
fected with cholera. 

Dr. Zudkoff of Moscow, w T ho had been formerly a 
contagionist, says, that he saw to his great astonish- 
ment, that all the attendants, and all the soldiers han- 
dled the sick, and supported their heads whilst they 
vomited, without using any precaution, and yet with- 
out being attacked by the cholera, 

14. Mr. Searie, who attends a very large number 
of patients in Warsaw, having charge of a hospital 
for the reception of the poor, writes, that not one of 
the hospital assistants— not one of the hospital at- 
tendants — not one of the nurses — not one of those 
who handled the dead, fell a victim to the disease. 

15. During a period of the late epidemic cholera in 
Berlin, 409 houses were visited by the disease, and 



AKD MEANS OF PREVENTION. 325 

in 273 of these, only one individual in each house 
was affected, while in the remaining 136, four or five 
suffered in each mansion. Such is the density of the 
population, in the parts of Berlin affected with the 
cholera, that the calculation assigns 4,200 families, 
making an average of four persons to each family, in 
the above number of houses, being an aggregate of 
16,800, who lived in the immediate contact with chol- 
era. Of this mass, 803 only were stricken with the 
disease, or about one in eighteen persons. 

16. Dr. Albers, in his official report to the King of 
Prussia, states, that during the epidemic, it is certain 
that about 40,000 inhabitants quitted Moscow ; not- 
withstanding which, no case is on record of cholera 
having been transmitted to other places. 

17. In the marine hospital of St. Petersburg, of 43 
attendants on cholera patients, not a single one w 7 as 
affected : and in the temporary hospital at the same 
place, of fifty -eight attendants, one only was affect- 
ed with cholera, and he after drinking kwass, when 
very warm. — Amer. Jour. Med. Sciences, 1832. 

18. Those engaged in post-mortem examinations 
of cholera patients, have not been attacked by the dis- 
ease. ' Such examinations,' say the physicians of 
Astrachan, i were made at our hospitals, without any 
precautions, with perfect impunity.' 

19. Dr. Foy, at Warsaw, and ten others, inocula- 
ted themselves with the blood of patients laboring 
under the cholera, tasted their dejections, and inha- 
led their breaths, without receiving the disease. — Ga- 
zette Medicale, 1831, 

20. As to the capability of merchandise to convey, 

and afterwards communicate the infectious germ of 
28 



326 CAUSES OF THE CHOLERA, 

cholera, the Central Board of Health, in a commu- 
nication to the Privy Council, remark : — 

' There is perhaps no question in the whole range 
of sanitary police, on which so many and such irre- 
fragable facts can be brought to bear as on this ; de- 
rived too, from the most authentic and recent sour- 
ces. 

Seven hundred and thirty ships loaded with hemp 
and flax, from infected parts of the Baltic, arrived at 
the different quarantine stations in this country, be- 
tween the 1st of June and the 31st of December, 
1831. 

Many vessels also arrived laden with wool and 
hides, yet not a single case of cholera occurred on 
board any of these ships outside theCattegate Sea, nor 
amongst the people employed in opening and airing 
their cargoes in the lazarets. 

At the hemp and flax wharfs in St. Petersburgh, 
where several thousand tons of these articles arrived 
during the spring and summer of this year, from pla- 
ces in the interior, where the cholera existed at the 
time of their departure for the capital, the persons em- 
ployed in bracking or sorting, and who generally pass- 
ed the night among the bales, did not suffer so early 
in the season, nor so severely, as other classes of the 
general population. 

The same observation holds good with respect to 
all the rope walks of St. Petersburgh, and the impe- 
rial manufactory of linen cloth at Alexandrofsky, 
where all the yarn is spun from flax bracked and 
hackled on the spot.' 

21. In England, we find still further proof of the 
non-contagious nature of the disease : — 

■" Down to the 29th of February, 1832, agreeable 



AND MEANS OF PREVENTION. 327 

ib the statement made to our government, by Mr. As- 
pinwall, American consul at London, but one medi- 
cal practitioner had died of cholera in England, al- 
though at a moderate computation, 1 ,000 or more have 
been in constant attendance on choleric patients." 

According te the Medico Chirurgical Review for 
April, 1832, ; not a single medical man has been af- 
fected by the cholera in Sunderland, Newcastle, or 
Gateshead. 5 

22. The cholera has not appeared to be contagious 
in France. ' From the medical officers of the Paris 
hospitals, Hotel Dieu and St. Louis, we have state- 
ments that, within those hospitals, the cholera has not 
shown itself to be contagious.' — Report of Mass. 
Med. Soc. on cholera* 1832. 

23. In this country, we find the like general ex- 
emption from the disease among the attendants upon 
cholera patients. Some, to be sure, have had 
the disease, but they have, more than others, been 
exposed to all the exciting causes of the complaint. 
Most of the physicians of Quebec and Montreal are 
satisfied that the disease is of an epidemic character, 
and not contagious. 

24. The following report bears testimony to the non- 
contagious nature of the cholera at New York. 

* Board of Health, July 24, 1 832. 
The Special Medical Council presented the follow- 
ing report, which was read and directed to be pub- 
lished : — ■■ 

<s To Walter Bowne, Esq., 
( President of the Board of Health. 
Sir, — I beg leave to address you upon the unne- 
cessary haste with which the bodies of persons who 



328 CAUSES OF THE CHOLERA, 

have died of cholera, have, in some instances, been 
interred. 

The council are of opinion that the dead may, with 
perfect safety to the living, remain unburied for at 
least six hours, even during the present warm seasorr, 
and, under proper precautions, for a much longer pe- 
riod. 

They also deem it expedient that the public should 
know that the neighborhood of the hospitals and bury- 
ing grounds has not been found, upon enquiry, to 
be peculiarly liable to the disease. At the pub- 
lic burying ground called the Potter's Field, where 
nearly one hundred bodies have been buried daily, 
during the past week, none of those engaged in the 
work have been taken ill ; and of the one hundred 
persons living in the Asylum for the Deaf and Dumb? 
within 200 yards of the same, not one is known to 
have been attacked. 

The medical and other attendants of the hos- 
pitals, not predisposed to the disease by their previous 
habits, have, also, so far as is known to the council* 
escaped its attack. 

In behalf of the Special Medical Council. 
ALEX. H. STEVENS, M. D. Pre*. 

By order of the Board of Health, 

3, MORTON, Sec%" 

25. Finally, if the facts which have been adduced 
by the contagionists are sufficient to prove the chole- 
ra to be essentially and generally a contagious disease, 
then every other epidemic which the world has ever 
known, may be proved to be so ; for, as 1 have said, 
whenever any disease becomes general, some circum- 



AND MEANS OF PREVENTION. 329 

stances will unquestionably occur, to favor the idea 
of the contagious nature of the complaint. Take for 
example, the Influenza, which, I believe, is not con- 
sidered at all contagious, at the present time ; cer- 
tainly it is not supposed to be propagated by conta- 
gion ; yet as striking, and well authenticated, and nu- 
. merous facts, and facts of the same kind, can be pro- 
duced to prove that it is so, as has been produced to 
convince the world that the cholera is contagious, and 
therefore quarantine regulations are necessary, &c. 
&c. I will refer but to a very few. 

Dr. Hamilton, describing the Influenza of 1782, 
says, " The first who were seized with the Influenza 
at Norwich, were two men lately arrived from Lon- 
don, where it then continued to rage. A sergeant in 
a regiment of foot, went to London on furlough ; the 
disease then raged in the capital. He returned in a 
few days to St. Albans, affected, and communicated 
it to the people in whose house he had his billet. 
This was the first of its appearance there, and from 
thence it spread rapidly all over the town." 

In 1803, tho Influenza prevailed very generally in 
England, Ireland, and other countries. The London 
Medical Society, wishing to collect materials for a 
complete history of the epidemic, addressed letters to 
more than fifty distinguished medical men, in various 
parts of the country, requesting answers to certain 
questions. Among the questions proposed, were the 
following : Has the present epidemic differed from 
former ones which you have seen? Has the present 
epidemic influenza appeared to you to be contagious ? 
Those who recollected former epidemic influenzas, 
generally answered that the diseases were similar ; 

but r^ore than one fourth of the physicians from whom 

28* 



330 CAUSES OF THE CHOLERA, 

answers were received were of opinion that the In- 
fluenza then prevalent was. contagious, the others, or 
about forty who returned answers, were of a contrary 
opinion. Among the facts stated by those who be- 
lieved the influenza to be contagious, I find the fol- 
lowing: Dr. Robert Percival, of Dublin, says the In- 
fluenza is " contagious, for it travelled from place to 
place, prevailed in London before it came to Dublin, 
&c. &x." Dr. Longfield, of Cork, says, "it appear- 
ed to be very contagious, as some boarding schools 
remained free until visited by some persons who 
brought it from the neighboring towns." Dr. Binns, 
of Ackworth, says, "that a school of 300 pupils in 
that town escaped the disease, and adds that at Crof- 
ton, another school of 60 young ladies wholly escaped 
the influenza, though it prevailed in the same village^ 
and the young ladies were much in the open air, but 
care was taken to prevent communication with the 
infected." 

Dr. Bardsley, physician to the Manchester Infirm- 
ary, states that "agentleman of Manchester returned 
from London, while laboring under influenza, found 
his family all w r ell, but next day three of them sick- 
ened of influenza, and two more on the following 
day. He further states, that the nurses of the House 
of Recovery fell sick soon after the reception of the 
first cases of influenza."* 

It will be unnecessary to multiply similar instan- 
ces ; no doubt they are to be found wherever influen- 
za or any other epidemic becomes general ; and as 
numerous and striking in proof of the contagious na- 
ture of the disease, as any that serve to convince 

* See Memoirs of the Medical Society of London, vol. d. 



AND MEANS OF PREVENTION. 331 

people that cholera is so ; and therefore quarantine 
regulations will be just as serviceable to prevent the 
spread of the influenza, as they can be, to stop the 
progress of the present epidemic cholera. 

Means of Prevention. 
The best method of preventing the cholera may be 
learned by attending to the causes which in all coun- 
tries have appeared to produce the disease. These 
causes, and which are of course to be avoided, are 
impure air, low and damp dwellings, crowded and 
filthy houses and cities, poor diet, intemperance, fear 7 
&c &c. 

Most countries and cities have published directions 
which have emanated from medical men, respecting 
the prevention of the disease. Such directions have 
undoubtedly been of great service. The following 
were published at Paris, by the Central Commission 
of Health. 

Course to he pursued to prevent the Cholera. 
" 1st. The little danger there is of being attacked by 
the cholera, should keep up the spirits. We should? 
therefore, not disturb ourselves, nor should we think 
of the disorder, but to adopt the precautions neces- 
sary to guard against it. The less fear, the less ha- 
zard. But as tranquillity of mind is a great preser- 
vative, we must avoid every thing which excites 
strong emotions, anger, fear, great exhilaration, &c» 

2d. It has been observed, that the purer the air, 
the less is the liability to cholera. 

Too much attention therefore, cannot be paid to 
the salubriousness of our dwellings. Care must be 
taken that many do not occupy, much more sleep in, 
the same apartment, that the premises be ventilated 
in the morning, and in the course of the day, by 



332 CAUSES OF THE CHOLERA, 

opening the windows and doors as often, and keeping 
them open as long as possible. It is proper also to 
place in dwelling houses, large earthen vases, con- 
taining chlorured water, (made by pouring upon one 
ounce of chloride of lime, one quart of water.) The 
purification of the air may be also produced by a 
clear and bright fire kept in the fire-place for a short 
time. 

Care must be taken that the doors and windows are 
not opened until after one is entirely dressed, so as 
not to be exposed to chills. It will be best to pass 
into another apartment during this operation, 

There should be no curtains about the beds, nor 
should any utensils be suffered to remain dirty, but be 
cleansed as soon as used, and always contain a little 
water. The humid air of dwellings, unhealthy at all 
times, becomes very dangerous when the cholera pre- 
vails, no clothes therefore should be dried in the sit- 
ting rooms, and especially not in the bed-chambers. 
Not only must the bed rooms be aired, but the utmost 
salubrity must be preserved in houses and out-houses. 
It is also important to cleanse privies with the great- 
est care> to purify them once a day with chlorured 
water, or water only. All their conduits should be 
closed except when in use. 

Every one should take care that house slops are 
emptied as soon as produced, that they do not remain 
between the pavements of the courts and allies, and 
that they pass off rapidly by the conduits and gutters 
which carry them to the streets. It is necessary in- 
deed to keep up this flowing by copious washings if 
the descents are not sufficiently rapid. 

The window panes should be washed at least once 
a week ; for the action of light is useful to health. 



AND MEANS OF PREVENTION. 338 

Every species of garbage both animal and vegetable 
requires great attention, their accumulation should 
therefore be prevented by the earliest possible re- 
moval of them. 

Useless domestic animals should be expelled. 
Swine, rabbits, fowls, and pigeons, &,c. should not be 
kept in confined places, or even in spacious courts 
where there is little air. The inhabitants of houses, 
particularly in the populous quarters, should in this re- 
spect watch mutually ; they should besides contribute 
each one his part, towards the cleanliness of the 
streets especially where they are narrow. It is the 
interest of all. 

3d. Chills are thought, by those physicians who 
have observed the cholera, to be among the causes 
most favorable to the development of the disease. 
Care should therefore be taken to dress warmly, and 
to guard the abdomen, and keep the feet from the 
action of cold. For this purpose it will be well to 
wear a woollen girdle, woollen or flannel under vests 
next the skin, and to use woollen socks, to be changed 
or washed when they become moist or dirty. The feet 
should be often washed in warm water. Overshoes 
should be worn when necessity obliges one to remain 
where it is damp or cold ; in a w 7 ord, people should 
so warm themselves that the feet should be protected 
from cold and moisture. 

Many persons, particularly of the lower classes, 
have the very bad practice of standing with their 
naked feet upon the cold ground when they go to bed 
and more so when they rise, and even walk upon it, 
This custom cannot be too much censured, as it be- 
comes particularly dangerous during the prevalence 
of the cholera. 



334 CAUSES OF THE CHOLERA, 

The fear of chills, even in summer, should prevent 
people from sleeping with their sashes raised. There 
should be a moderate temperature within doors ; for 
rooms that are kept too warm, render their occu* 
pants, more susceptible to the cold to which they are 
exposed on going out. 

For the same reason it is proper to keep early 
hours and not pass part of the night in promenading, 
going to meetings, to the coffee houses, ale houses, 
taverns, &,c. above all when the nights are very cold 
and damp. 

4th. To endeavor to lead an active life, shunning 
as much as possible, excess of fatigue, is one of the 
best means to insure tranquillity. Occupations which 
involve men in disputes are injurious. The same 
may be said of labors which occasion a deprivation 
of usual sleep at night. 

Mention has already been made of the usefulness 
of woollen girdles and socks; but these vestments 
should always be kept clean. Cleanliness is always 
necessary to health. They who have the means of 
taking occasional tepid baths, will do well to use 
them, but must remain in them no longer than may 
be necessary to clean their persons ; care should be 
taken to wipe with warm linen, and to avoid imme- 
diate exposure to external air on leaving the bath. 
This precaution is specially useful when the season is 
cold. 

Dry frictions are beneficial. They are easy to be 
administered by rubbing or having rubbed, in the 
evening, or better morning and evening, the body, 
arms, thighs, and legs, for a quarter of an hour, with 
a soft brush or a piece of woollen cloth. 

In reference to dress, the season will best deter- 



AND MEANS OF PREVENTION. 335 

mine its character, but in no case should people dress 
too slightly. 

6th. When the cholera prevails, the mode of living 
is a matter of great importance. Sobriety cannot be 
too strongly recommended. Very many cases are 
known in which the cholera followed the excesses of 
the table, and it is proved that the intemperate are 
particularly exposed to this malady. 

Well cooked provisions, roasted and not too fat, 
fresh fish, eggs for those who have good digestion, 
and light and well baked bread, should form the chief 
nutriment. 

Among vegetables, the least aqueous and lightest 
should be preferred. We do not think of excluding 
from these last, potatoes of good quality. We even 
approve of dry haricots, lentils, peas and beans plain. 
Crudities, such as salads, radishes, &c. are injurious. 
Salted provisions and salt fish should be avoided, and 
swine's flesh used as little as possible. Heavy and 
rich pastry are altogether prohibited. 

In the season of fruits, it is necessary to be very 
cautious in their use, above all, when they are not per- 
fectly ripe, for they may prove very dangerous. Cook- 
ed fruits are less exceptionable, but they should nev- 
er be eaten in great quantities ; and still less should 
they form the chief part of the meal. There is some 
food, healthy in general, but which, by a peculiar 
state of the stomach, is of difficult digestion with some. 
Every one, in this respect, should consult his stom- 
ach. 

Beverages do not require less circumspection in 
their use. Very cold drink, taken when one is warm, 
is dangerous. There is no necessity for quenching 



&36 CAUSES OF THE CHOLERA, 

thirst, except when perspiration ceases ; that is, no 
necessity for cold drink when one is in a sweat. 

The consequences of this abuse are fatal, in pro- 
portion to the coldness of the drink. The water 
should be clear ; filtered water is preferable to all 
other. It should be whetted with a very little vinegar 
or brandy when we wish to drink it pure, (two spoon- 
fuls of brandy, or one of vinegar to a pint of water) 
especially if the season is warm, and one is obliged to 
do corporeal labor, which, by exciting perspiration, 
provokes thirst, and makes it necessary to drink often. 
Reddened water, that is, water to which a little good 
wine is added, is also beneficial. In short, water 
slightly aromatic may be successfully used, that is, 
having a stimulant infusion of peppermint, or camo- 
mile (a pinch of mint, or six heads of camomile to a 
half pint of boiling water, to which add, after cooling, 
half a pint of cold water). 

Nothing is more pernicious than the abuse of strong 
liquors. It has been proved by a great number of 
cases, that the cholera attacks the intemperate, and 
even those who without making an habitual use of 
strong drinks, commit occasionally by enticement, a 
single excess of this kind. 

The use of ardent spirits, taken alone and before 
breakfast, a habit so common among the lower class 
of work-people, and so hurtful at all times, becomes 
particularly fatal when cholera prevails. Persons 
who have this habit should eat something, at least a 
piece of bread, before swallowing the brandy. White 
wine should not be taken before breakfast, without 
the same precaution ; and then only in the smallest 
quantities. 
During the prevalence of the cholera, bitter brandy, 



AftfD MEANS OF PREVENTION. 337 

that is, brandy into which bitter and aromatic plants 
are infused, or rather Absynth brandy, is preferable 
to common brandy. Wine taken in moderate quan- 
tity, is a proper beverage during and at the end of a 
meal 5 but it should be of good quality. It is better 
to drink half the quantity and have the quality superi- 
or. New and sharp wines are more hurtful than 
beneficial. Red wine is preferable to white. The}? 
who have the means of mixing it with gaseous water, 
such as Seltzer water, natural or manufactured, will 
do well to supply themselves with this salubrious and 
agreeable drink. 

Beer and cider, especially when new, when not 
well fermented, or when sour, dispose to cholics and 
diarrhoea, and thus become very dangerous. What 
has been said, applies with stronger force to sweet or 
new wine. 

(Signed) 

JUGE, 

PAR1SET, 

ESQUIROL, 

CHEVALLIER, 

LEROUX, 

LEGRAND, 

BARON DESGENETTES, 

The Edinburgh Board of Health say, " Experi- 
ence has shown, that the most essential precaution 
for escaping the disease is sobriety,— that intoxication 
during the prevalence of the epidemic is almost sure 
to be followed by an attack,— and that those addict- 
ed to drinking are the most subject to take cholera, 
and the most likely to sink under it. In like manner, 

strict attention to personal cleanliness, — to cleanli- 
29 



338 CAUSES OF THE CHOLERA, 

ness and ventilation of dwelling houses, — to wiarm 
clothing, — to regularity of hours for sleep, — to keep- 
ing as much as possible within doors at night, — -and 
to taking food before going out in the morning, — may 
be relied on as important means of security." 

The measures adopted in Edinburgh for security, 
appear thus far, to have been remarkably successful ; 
but judging from all the facts known respecting the 
causes and progress of the cholera, it still remains 
very doubtful whether Boards of Health, organized 
as they are in this country with very limited powers, 
especially in small towns, are capable of doing much 
that is effectual towards preventing the disease, and 
there is reason to fear they frequently do much inju- 
ry by exciting alarm, which their frequent meetings 
are sure to create, and by their assurances to the pub- 
lic that the very first case of cholera shall be announ- 
ced, as if some exceedingly contagious disease was 
expected to arrive.* 

In order to be able to do much good, when a dis- 
ease similar to cholera is likely to prevail, Boards of 
Health require the power to change the habits of the 
sensual, the vicious, the intemperate, and above all, the 
power to clothe and feed the poor, and to provide cleanly 
and comfortable dwellings for all classes in community. 
But they have not this power. The only power which 
exists in this country to stay the scourge which has 
ravaged Asia and Europe, and now threatens us, is 
in the possession of the rich. On them must fall the 

* An agent of a large manufacturing establishment in an inland 
town, far from any place where the cholera prevailed, told me that 
the day after a committee from the Board of Health visited his estab- 
lishment, 30 or 40 of his workmen determined to leave, on account of 
the cholera, assigning this call from the Board ofHealth, as the only 
reason for their supposing the cholera was soon to prevail among 
jrtiem. No fear of the disease had prevailed previously. 



AND MEANS OF PREVENTION. 339 

burden of relieving the wants of the suffering, and of 
thus preventing and mitigating the severity of this 
dreaded epidemic. 

Is the present epidemic cholera, a different and 
distinct disease from the common cholera morbus ? 



Sydenham described an epidemic cholera morbus, 
which prevailed in England in 1669. He calls the 
disease cholera morbus, and did not suppose the dis- 
ease differed from the common cholera, except that 
this year, it prevailed epidemically. The Bombay 
Medical Board say that this description by Syden- 
ham, applies exactly to the cholera of India. There- 
fore, the people of India might attribute their disease 
to importation from England. 

The Report of the Royal Academy of Medicine, 
of Paris, says, 'The cholera of India is, as to its 
symptoms, the cholera of the ancients, and except 
in intensity and danger, differs but little from ordinary 
cholera.' The most intelligent physicians in Eng- 
land, are of the same opinion. 

Dr. Kane, of Plattsburgh^ N. Y. who saw much 
of the epidemic in Montreal, says that the physicians 
of Montreal view the present epidemic, or Asiatic 
cholera, as it is called, ' as differing in no respect from 
the endemic cholera of the United States and the 
Canadas, save that now it is epidemic. The same 
organs are affected, and the same symptoms exhibit- 
ed.' 

The common cholera morbus of this country is 
usually considered as not a very dangerous com- 
plaint ; but most writers mention that it often is so, 
and frequently terminates life in a few hours. By 



340 CAUSES OF THE CHOLERA; 

referring to descriptions of the symptoms of this dis- 
ease, as found in old medical works, we find the vom- 
iting, purging, cramps, spasms, and most of the symp- 
toms which the Asiatic cholera exhibits, all alluded 
to. It is true, however, that most of the old writers 
consider the cholera to depend upon a redundant se- 
cretion of bile. This is, undoubtedly, an erroneous 
conclusion, and arose, probably, from regarding the 
effects of the disease as the cause of it. Later pa- 
thologists have shown, that the secretion of bile, es- 
pecially an excessive secretion, takes place, only, af- 
ter the disease has continued sometime, and not until 
reaction is produced. Sydenham, however, does not 
allude to bile being present, in the first discharges, but 
says they are thin and watery ; and Frank says, i at 
first, the egesta are like water, then, as if flesh had 
been recently immersed in them, — sometimes they 
are white,' and adds, ' in the worst cases of cholera? 
the patients exhausted by profuse discharges, and 
their torments, become collapsed in five or six hours ? 
and look no longer like themselves. 5 

No symptoms have been described as occurring in 
Asiatic cholera, that do not sometimes occur in com- 
mon cholera. Some insist much upon the dischar- 
ges being different. In allusion to this opinion^ the 
Medico Chirurgical Review* says, — 

" Great stress is laid on the nature of the ejected 
matters in cholera. If the fluids are colorless, it is a 
proof that the disease is Asiatic — if any bile or other 
colored fluids appear, the disease is English. Yet 
the India Boards, and, indeed, all careful observers* 
have acknowledged that the discharged fluids form 
no criterion of the disease. The Bengal Board, for 
example, tells us that fe the fluid ejected from the stom- 



AND MEANS OF PREVENTION. 341 

ach was watery ; mostly tasteless, transparent, Or of 
a whey or ash color. Sometimes it was sour, green, 
dark, like infusion of tea, starchy, mixed with mucus, 
and viscid. In very rare cases, pure bile was thrown 
up. 9 In respect to the alvine evacuations, they were 
4 generally watery, colorless, white or muddy ; — some- 
times red and bloody, sometimes greenish and pulpy, 
like half digested vegetables. 5 Is it not preposterous, 
after this, to make the distinction between Asiatic 
and English disease to consist in the color of the 
motions? Nimium ne crede colori !" 

From these and numerous other facts which might 
be adduced, it is evident that the Asiatic cholera does 
not differ from our common cholera, except that the 
first is epidemic, and far more dangerous and in- 
tense, than we have been accustomed to witness the 
latter. This intensity is most strikingly manifested 
in the immediate sinking of the circulation, which is 
the most essential and diagnostic symptom of the pres- 
ent epidemic disease. 

The question is also asked, if a similar epidemic ev- 
er prevailed before in this country ? If such an epidem- 
ic has prevailed, I cannot find that any records of it 
have ever been published. 

Mr. Webster, in his valuable and very erudite 
work on the history of epidemic and pestilential dis- 
eases, makes no mention of a similar disease, though 
his researches have been very extensive. He alludes 
however to destructive epidemics that have prevail- 
ed among the Indians, and other inhabitants of this 
country, which might have been of this character ; 
but as the symptoms of these diseases are not given, 
behave no means of judging. 
29* 



042 CAUSES OP THE CHOLERA, 

The Report on Spasmodic Cholera, prepared by a 
Committee of the Mass. Med. Society, says, ' the 
pestilential fever of New England, and which pre- 
vailed in Massachusetts, Connecticut, Vermont, &c, 
in 1806 — 7, and 1811 — 12, bore more resemblance to 
the cholera as to its extension and duration than any 
other disease that has prevailed in this country. Oth- 
ers have supposed the diseases are the same. But 
from an examination of the accounts of the New 
England pestilential fever, written by those who saw 
much of the latter, it is very evident they are diseases 
of a dissimilar nature. 1 am confirmed in this opin- 
ion by a physician* of high qualifications, who saw 
much of the fever, when it prevailed several years 
since, in Worcester Co. Mass. and who has recently 
had abundant opportunity of seeing the cholera at 
Albany and New York, and who assures me the dis- 
eases do not resemble each other, neither in the symp- 
toms, nor in the appearances on dissection. 

Cholera and other bowel complaints have been r 
however, far more prevalent and fatal some years 
than others, in this country. During the past year, 
a very singular and malignant disease prevailed at 
Warwick, a hilly town, in Franklin Co. Mass. Judg- 
ing from the description of the disease which I have 
received from Dr» Jarvis, a very intelligent physician 
of Northfield, Mass., it bore a striking resemblance 
to the present epidemic cholera. The disease com- 
menced in July, and in five weeks, 32 individuals 
were attacked, of whom 16 died. The disease com- 
menced by distress at the stomach, extending to 
the bowels, then nausea, and vomiting, and fre- 
quent calls to stool, the discharges were white 
Dr. Flint, Northampton, Mass. 



AND MEANS OF PREVENTION. B43 

and watery. If the disease was arrested here, the 
dejections became bilious, and the patients recover- 
ed, but if not arrested, the vomiting increased ; 
nothing could be retained on the stomach but opium ; 
the discharges from the bowels constant, and of a thin 
fluid, resembling rice water ; intolerable thirst, cramps 
of the abdominal muscles and extremities : the skin 
became cold, shrunken, and of a leaden hue, pulse 
weak, and often imperceptible \ the mind not weak- 
ened or disturbed, the patients exhibiting but little 
anxiety for themselves, but conversed freely until the 
last. 

Such is an abstract of the brief account of this sin- 
gular malady which 1 have received from Dr. Jarvis; 
it is hoped he will soon furnish the profession with a 
more detailed history of the disease. 

It is very probable that in other parts of the coun- 
try similar diseases have appeared, and which have 
borne a very close resemblance to malignant cholera, 
and have been to a considerable degree epidemic. 
Such had been noticed in England, previous to the 
appearance of the cholera at Sunderland. 

In the autumn of 1825, a disease broke out at 
Leeds, in England, which exhibited all the symptoms 
of the Asiatic cholera, vomiting and purging of a flu- 
id resembling barley water, intense spasmodic con- 
tractions, cold, clammy skin, small, and often imper- 
ceptible pulse, skin contracted, and of a purple hue. 
Some lingered for a day or two, whilst others died in 
two or three hours. — Medico Ckirurgical Review for 
April, 1832. 

In August, 1831, violent cases of cholera occurred 
at a school in Clapham, Eng. Of 22 boys 20 were 
attacked with vomiting and purging, of an alarming 



344 CAUSES OF THE CHOLERA, &c. 

character in the course of six hours. The matter 
vomited was sometimes tinged with bile, but for 
the most part it was colorless and inodorous. A few 
died, but most of them recovered. On careful ex- 
amination of the food they had eaten, nothing was 
discovered likely to cause the disease ; but it was af- 
terwards ascertained that a very foul drain in the rear 
of the school house, had been accidentally opened a 
day or two before the disease appeared ; and the con- 
tents of this filthy receptacle were thrown into a 
yard adjoining the play ground for the boys. 

A disease somewhat similar, though less violent has 
just occurred among the prisoners in the Mass. 
State prison, atCharlestown. During the night of the 
5th of Aug. 115 of the convicts were attacked with 
disorder of the stomach and bowels, 49 of whom 
were so sick as to be sent to the hospital. The same 
day, 15 similar cases occurred at the House of Indus- 
try, South Boston. The physicians report that the 
disease is not spasmodic cholera, nor the common 
cholera of the country, and that they have not discov- 
ered the cause that produced it. None of the cases 
iiave proved fatal. 



THE INFLUENCE OF FEAR IN PRODUCING AND 
AGGRAVATING THE EPIDEMIC CHOLERA. 

Almost every person who has written upon the 
causes that produce the cholera, mentions the fear of 
the disease, as among the most frequent and powerful. 
This exciting cause^ has, however, been much more 
frequently alluded to by the medical men in England, 
France, and the United States, than by those of In- 
dia. We are therefore to presume that the fear of 
the cholera, has been greater, and more manifest, in 
the above named countries, than it was in Asia. This 
is not at all surprising, for if the disease had never 
been known as an epidemic, and was now to appear in 
this country, or any part of Europe, and be as fatal 
as it has ever been, the people in general, away from 
its immediate neighborhood, would not, for some 
years, be but very little excited or alarmed. But now 
we have added to the terror created by the daily rav- 
ages of the disease, the greater terror arising from the 
knowledge of its great mortality and general preva- 
lence in other countries. This was not the case in 
India. 

Again, the people of India are not, in general, a 
reading people, whilst the Europeans and Americans 
are so : and by means of newspapers and other pe- 
riodicals, and the facilities for conveying information 
rapidly from one part of the country to another, eve- 
ery man, woman, and child, hears daily of the pro- 
gress and the ravages of the disease. 

So much has been written upon the disease, and 
read by the general community, that its history is not 



346 CAUSES OF 

only well known to all, but all the symptoms which 
may or may not be premonitory of cholera, are well 
understood. The exciting and predisposing causes, 
the articles of diet to be used or avoided, the remedies 
to prevent and to cure, are all treasured up, and have 
had the effect to create a morbid excitement respect- 
ing the disease, throughout the whole mass of com* 
munity* 

These are, probably, among the causes that make 
the fear of the disease to be far greater, and more in- 
jurious in its effects, and more powerful to excite the 
disease in this country, and in Europe, than it was 
in Asia. 

It is, probably, the great influence of this cause 
alone, that makes the cholera nearly as violent and 
fatal here as it was in India, although all the other 
causes are far less powerful* 

But not to take too much for granted respecting 
the influence of this passion in producing and aggra- 
vating the cholera, let us inquire if it is true that it 
has the power ascribed to it. Let us learn what the 
effect of fear is upon the human system. Let us first 
enquire of medical men of experience. 

" Fear," says Haller, " diminishes the powers of 
the body, enfeebles the movements of the heart, 
and weakens the circulation. Influenced by this 
passion, the scurvy and other diseases become more 
fatal, putrid and contagious maladies acquire more 
malignity, and the body becomes more disposed to 
be affected by pestilential miasmata." 

"Fear," says Dr. Falconer, (Treatise on the Influ- 
ence of the Passions on the Diseases of the Human 
Body) " diminishes the power of the heart, enfeebles 



THE CHOLERA. 347 

the pulse, and sometimes to such a degree that the 
blood does not flow on opening a blood vessel. Fear 
also arrests the natural secretion, and produces this 
remarkable effect, which is, to render those who are 
frightened more subject to be attacked by contagious 
diseases." 

M. Virey, (Diet, des Sciences Medicales, Vol. xxxix) 
says, that " fear is engendered when, according to 
Homer, the mind or soul descends from the body in- 
to the lower extremities, iofly." It produces de- 
rangement of the secretions, cold perspiration, a re- 
cession of the blood from the surface to the hearty and 
diarrhoea, a coldness and paleness of the skin, and 
when extreme, arrests the circulation of the blood 
and the secretions." 

Dr. Burrows (On Insanity) observes that "fear 
produces embarrassment in the motion of the heart, 
the blood is detracted from the extreme vessels, as is 
evinced by a death like paleness. It depresses and 
enfeebles the action of the heart, diminishes the quan- 
tity of blood flowing to the brain, and debilitates the 
nervous power." 

A late writer and distinguished physician, (Alibert, 
Physiologie des Passions,) says that " Fear is of a 
contagious nature, and its effect upon the body is to 
produce a retrocession of the blood from the exterior 
to the interior, and to derange or suppress all the func- 
tions of assimilation." 

Other authorities might be produced to show the 
dangerous effects of fear upon the human system, its 
influence to produce and spread spasmodic complaints, 
and its tendency to become epidemic, during great 
public calamities : but it will be unnecessary to multi- 



348 CAUSES OF 

ply them, to demonstrate that this passion not only dis* 
poses a person to be affected by a contagious disease, 
but actually produces a disease and symptoms similar 
to the premonitory symptoms of cholera. Facts innu- 
merable might be adduced to show that fear alone is 
sufficient, and often, very often, does produce the 
same symptoms that are now called premonitory 
symptoms of cholera. 

1 have seen repeated instances of diarrhoea produ- 
ced by mental anxiety. 1 knew an instance of a 
clergyman of great sensibility, who for more than a 
year had a diarrhoea, from this cause, every Sabbath 
morning. 

Long continued and anxious attention to the 
sensations and feelings of the bowels, will tend to dis- 
order them. A person whose mind is constantly on 
the alert to detect some symptoms of disease of the 
stomach or bowels, who anxiously watches the effect 
of every thing he eats or drinks, upon the organs of 
digestion, will be very certain to create in them a 
morbid sensibility, which will be followed by indiges- 
tion, diarrboea or other disease. 

It may be said the cholera attacks children who 
have no anxiety, or have no knowledge of the disease. 
This may be true to some extent, but it should be 
recollected that children have been remarkably ex- 
empted from the disease. Besides, according to my 
observation, most children of five or six years of age, 
and upwards, have much anxiety respecting this dis- 
ease, of which, to be sure, they know nothing, except 
that it is some approaching and fearful calamity. In 
children, fear, like other passsions, is soon effaced, 
but it is also more sudden and powerful in them, and 
far more likely to endanger them by its effects upon 






THE CHOLERA. 349 

their susceptible and delicate nervous system. A 
school in the interior of Massachusetts was broken 
up for the day by the fear of cholera, produced by the 
sickness and vomiting of one of the children. The 
cry that the cholera had come, produced the 
same symptoms in so many of the pupils, that the 
school had to be dissolved. 

The distinguished physician* of a celebrated insti- 
tution, situated within a short distance of the house 
where two persons died of cholera, in Hartford, told 
me that the day after this occurrence, all the inmates 
of the institution who had heard of the deaths by chol- 
era, were affected by diarrhoea, the cause of which, 
he attributed to the influence of fear and anxiety. 

From such, and many other instances of a similar 
character which have come to our knowledge, is there 
not great reason to apprehend that many, very many 
cases of cholera, if not produced by fear alone, are 
aggravated by it to a dangerous degree, and cases of 
common cholera, transformed through the influence 
of fear, into the malignant and fatal ? 

From several parts of the country, we receive pub- 
lished reports of Boards of Health, of mild cases of 
Asiatic cholera. These cases recover. But in a day 
Or two after, we learn that the anxious and alarmed 
relatives, and the attendants upon these mild cases, 
who have been deprived of their usual rest, regular 
meals, and who are fearful of becoming sick, have 
sickened and died. Such cases are then attributed 
to contagion, as if the other causes in powerful opera- 
tion, and which have produced the disease in all other 
countries, were not here in operation. 

* Dr. Todd. 

30 



350 CAUSES Of 

If the assertions of medical men in all parts of the 
world, respecting the influence of fear in producing 
disease, and especially the cholera, are not wholly 
groundless and false, then it is all important that 
medical men and public authorities endeavor to allay 
excitement, and if possible, the panic which univer- 
sally prevails throughout this country, respecting the 
epidemic that prevails. Though, to be sure, this dis- 
ease is a distressing visitation, yet there is abundant 
reason to believe, that with proper care in avoiding 
the causes that excite it, it will prove no more de- 
structive of human life in New England, than Influ- 
enza has some years been, and far less so than Scar- 
latina and some other complaints have frequently 
been. But if the causes which are known to produce 
it, are not avoided; the disease will undoubtedly pre- 
vail, for as we have seen, quarantine regulations are 
worse than useless. 

The general influence which renders certain exci- 
ting causes so powerful in producing the disease, is 
above us, and every where around us, and over which 
we have no control. We might as well attempt to 
stop the wind, or allay the tempest by quarantine 
edicts, as to prevent the spread of the atmospheric 
poison. Our hope is in our general habits of tempe- 
rate but good living, our cleanliness and thin popula- 
tion, and above all, in our moral courage, and the in- 
dulgence, not only of the hope, but the belief 'that we 
shall escape if we avoid the exciting causes. 

We know how powerful has been the influence of 
faith and hope, to lessen the ravages of other diseases. 

When the plague prevailed at Messina, in Sicily, 
in 1743, and at a time when it raged with unabated 



THE CHOLERA. 351 

fury, the people took down from the great altar, the 
ancient image of their tutelary saint, the Holy Mary r 
the Mother of God, and carried it in procession 
through the streets. From that day the plague began 
to decline. — ( Turrianoh treatise onplague at Messina.) 

But we need not seek far back in history, nor 
among an ignorant race of men, to find instances of 
the influence of panic in the diffusion of epidemic dis- 
ease. 

Dr. Stanford, of the Medical staff, communicated 
the following information to Dr. Ferguson. "In the 
autumn of 1813, he was stationed, with part of the 
British army, at Cadiz, when an irruption of yellow 
fever took place. Some of the medical men were 
staunch contagionists, and impressed their belief upon 
the corps to which they belonged ; in all these, the 
disease was most fatal to great numbers. The men 
were half dead with fear, before they were taken ill, 
and speedily became its victims. But in the other 
regiments, where no alarm had been sounded, the 
the soldiers took the epidemic with steady courage, 
and generally escaped an attack, and if not, they re- 
covered from it in a large proportion." 

At the present alarming time, no duty of medical 
men, and all those who have influence over the faith 
of others, as regards the epidemic, seems more impe- 
rative, than that they should steadily endeavor to quiet 
public alarm, and constantly abstain from creating 
any fear as respects the prevalence of the disease, and 
its contagious nature. Hundreds will die of common 
cholera, if they are not assured, and made to believe 
that the disease which affects them, is not the cholera 
which their fears suggest. In such cases, every look 
and question and action of a physician, is very impor 



352 CAUSES OF 

tant. In such cases, he has it in his power, not only 
to endanger the sick, but to spread around a far more 
dangerous contagion than that of cholera, the conta- 
gion of fear 5 to drive from the bed of sickness, the 
anxious relatives and useful attendants, palsy the 
hand of charity, and create in those who are obliged 
to attend upon the sick, a disposition to a disease, 
closely allied to, if not the malignant cholera. 

Never before has the world been visited by a dis- 
ease, in which fear has had so dangerous an influ- 
ence ; for the passion of fear falls in with, and unites 
with the disease, and attacks and paralyses the same 
organs. Both fear and the cholera drive the blood 
from the exterior upon the heart, arrest or derange 
the secretions, hinder assimilation, and of course pro- 
duce indigestion, and disorder of the stomach and 
bowels. 

Upon this subject, the Medico-Chirurgical Review^ 
remarks, " Medical men will now see how much they 
will have it in their power, when the cholera comes, 
to pronounce or withhold sentence of desolation upon 
a community. The word contagion will be the word 
of doom ; for then the healthy will fly their houses, 
and the sick be deserted ; but a countenance and 
bearing devoid of fear, will command the aid, and 
inspire the hopes that are powerful to save in the 
most desperate cases." 

If any should still be of opinion that the disease is 
contagious, and rely upon some few facts that have 
occurred in the progress of the disease in this country, 
such as the attendants on the sick being attacked by 
the disease, to justify their opinion, let them reflect 
that all these cases may have originated from terror 
and other exciting causes, without contagion having 



THE CHOLERA. 353 

any agency. Let them reflect that similar cases 
have occurred in other countries ; but when the epi- 
demic has passed away, and sanity upon this subject 
restored to the community, they have been seen to 
have originated from other sources than contagion. 

In proof of this, 1 will cite a late resolve of one of 
the most intelligent Medical Societies in the world, 
the members of which, from their learning, and from 
their intimate acquaintance with the disease, were 
as well qualified to judge respecting its nature, as 
any other body of men whatever. 

Westminster Medical Society r , April 28, 1832. 
This being the last meeting of the Society for the 
session, the discussion " On the nature, character, 
and treatment of cholera morbus," was concluded by 
the adoption of the following resolution, Dr. Gran- 
ville moving, and Dr. James Johnson seconding : — 
" That the Westminster Medical Society, having de- 
voted the uninterrupted space of six months to the 
serious and dispassionate consideration of the mala- 
dy which has been prevailing in England since the 
latter end of September last, and especially in the 
metropolis, and having heard the several arguments, 
depositions, doctrines and facts of the many mem- 
bers practically, as well as theoretically engaged in 
that important enquiry, declare, that, in the opinion 
of the majority of the society, the evidence brought 
forward to prove the said malady to be a contagious 
disease has completely failed ; and that every circum- 
stance which has come to the knowledge of the So- 
ciety, shows the disease in question to have begun, 
progressed, and ended in the ordinary way of every 

other epidemic disorder." 

30* 



APPENDIX. 



NOTE A. 

RECENT PROGRESS OF THE CHOLERA 
IN EUROPE. 

The cholera, whirh first commenced its ravages in the north of 
England, in Oct. 1831, soon spread to Scotland, and reached 
London early in 1832. In neither of these places has it yet pre- 
vailed with great violence \ and by the end of April, had nearly 
disappeared. The disease extended into Ireland, and prevailed 
at Dublin and Cork in the month of April. The 24th of March 7 
1832, it first appeared at Paris, where it increased with great 
rapidity. Some days, the deaths amounted to nearly one thou- 
sand. The printed reports give 861 deaths on the 9th of April, 
It has been calculated that 20,000 died of cholera at Paris be- 
tween the 24th of March and the end of the following April 
We look with much interest for accounts from Paris, respecting 
the causes which rendered the disease so much more violent at 
this place, than it had been in other towns in Europe. We shall 
expect from the medical men of Paris, minute and important 
details relative to the appearances observed on dissection ; and 
also as regards the age, sex, professions, &c. most affected by the 
disease. The cholera began to decline in Paris towards the end 
of April, but has not yet entirely disappeared from that city. The 
latest accounts received from Paris, state that the disease was 
again on the increase. During the last six days of June, 271 
deaths from cholera occurred in that city. We also know that it 
still prevails in several other towns in France. The cholera also 
prevailed the 1st of July in Dublin, London, Liverpool, Man- 
chester, and several other towns in England and Ireland. The 
following is the latest account received : 

Council Office, July 4. 
England and Scotland. — New cases, 378 — deaths, 138— re- 
covered 150 — remaining, 787. Total cases from commencement, 
14,919— total deaths, 5,54L 



356 APPENDIX 

Since the appearance of the cholera in Europe, numerous 
treatises, lectures, essays, and letters respecting the disease have 
been published ; and some of them contain the opinions of the 
most celebrated medical men in Europe. Many of the works, 
however, suggest no new views of the nature of the disease, nor do 
they recommend any method of treatment that has not already 
been alluded to. 

Dr. Binaghi witnessed the disease at Warsaw, and has pub- 
lished his opinion respecting it. This opinion has been transla- 
ted from the Italian, by Wm. Sampson, Esq., and published re- 
cently at N. York. Dr. B. thinks the cholera is a disease of the 
nervous system, and principally of the nerveo-splanchnic sys- 
tem. The direct cause of the disease he says is unknown. He 
thinks the cholera is not contagious, but may be an epidemic, 
produced by the variations of the seasons. He says it prevails 
longest in soils that are low, flat, humid, and populous. He ad- 
vises, as preventive of the disease, to avoid exposure to sudden 
changes of weather, and to keep the skin and feet constantly 
warm, to eat moderately of nourishing food and avoid the use 
of unripe and acid fruit. 

His method of cure is as follows. First, establish a point ol 
counter irritation on some unimportant part of the body, by moxa 
or the actual cautery to the back, breast, abdomen or limbs, and 
keep all the surface of the body warm, and moderate the violent 
internal action by Sydenham's laudanum in large doses, and to 
give warm drinks. In the first stage of the disease he condemns 
the use of internal stimulants ; but in the second stage he thinks 
they may be useful and necessary, and recommends the use of 
quinine, piperine, bark, &c. &c. 

The opinion of the celebrated Dupuytren respecting the na- 
ture and treatment of the cholera, has aLso been published. He 
believes the cholera has its seat in the alimentary canal, and con- 
sists of an irritation of the secretory apparatus, and especially 
of the small glands or mucous follicles of the intestines. From 
these he thinks the superabundant evacuations proceed. To al- 
lay this irritation, and stop the discharges, he recommends the 
application of leeches, in the first instance to the abdomen, and 
the administration of frequent and large draughts of a strong de- 
coction of poppy heads ; but above all he depends upon the ad- 
ministration of sugar of lead, either in pills or solution. If the 
stomach can not retain the medicine, he advises the application 
of a large blister to the abdomen, and after removing the epider- 
mis, to sprinkle one half of the wound with sulphate of morphine, 
and the other half with pulverized sug'ar of lead. 



The following table exhibits the propoportion of deaths, to the 
population, in some of the large cities of Europe : — 



APPENDIX. 35f 

The first column of figures shows the total population, and the 
second, the number of deaths from cholera, during the prevalence 
of the disease, up to the 19th of April, at which time it had dis- 
appeared from many of the places named, and had passed 
through its worst stages in the rest. 

Moscow, 350,000 4,690 equal to 1 in 74 

Petersburgh, 360,000 4,757 1 74 

Vienna, 300,000 11,896 1 159 

Berlin, 340,000 1,401 1 242 

Hamburgh, 100,000 446 1 224 

Prague, 97,000 1,335 1 72 

Breslaw, 78,000 670 1 116 

Konigsberg 70,000 1,318 1 53 

Magdeburgh, 36,000 346 1 104 

Braun, 33,000 601 1 54 

Stettin, 24,000 250 1 96 

Halle, 28,000 152 1 184 

Bliberg, 22,000 253 1 77 

London, 1,500,000 1,223 1 1,228 

Edinburgh, 150,000 72 1 2,033 

Glasgow, 180,000 395 1 455 

Paisley, 60,000 204 1 294 

Hungary, 8,750,000 188,000 1 46 

Paris, 800,000 20,000 1 40 

If to these be added, 

Montreal, 25,000 1,250 1 20 

Quebec, 22,000 1,790 1 12 

N.York, 200,000 2,000 1 100 

Albany, 24,000 311 1 77 

It should be recollected, however, that the population of Que- 
bec and Montreal, had been greatly increased by the arrival of 
emigrants, at the time the cholera appeared at those places. But 
notwithstanding this, it is a well established fact, that the disease 
has been full as malignant on this continent as in any part of the 
world, and even a greater number of those attacked, and who 
have received medical aid, have died in this country, than in In- 
dia, among those similarly situated. This will be made evident 
by referring to the table of recoveries and deaths in India, page 
149 of this volume, 

The following important facts and tables, are selected from 
the 'Bibliotheque Universelle,' for Dec. 1831. 

] . At Posen, a city containing 30,000 inhabitants, more men 
died than women, of the cholera. Of 541 deaths, 303 were 
males, and 238 females, and of the following ages :— 



35S APPENDIX. 

Under 1 year, 5 

From 1 to 7 38 

8 years to 14 35 

15 to 28 104 

29 to 42 145 

43 to 56 111 

57 to 70 73 

Above 71 30 

Total, 541 

At Berlin, the same facts were noticed, as is evident from the 
following account of the first 1,500 cases of cholera. 

Men. Women. Total. 

From 1 to 10 years, 145 99 244 

11 to 20 62 60 122 

21 to 30 106 105 211 

31 to 40 175 125 300 

41 to 50 135 116 251 

51 to 60 85 96 181 

61 to 70 65 67 132 

71 to 80 21 28 49 

81 to 90 3 7 10 

Total 797 703 1,500 

2. At Posen. the makers of brick, and the pewterers, suffered 
more than these who belonged to other professions. 

The table on the following page respecting the first 1,000 ca- 
ses of cholera, is very curious and interesting. 



APPENDIX. 



Employments of the first 1,000 Cholera Patients, 
at Berlin. 









under 










1 


t 


15 yrs. 


H 


O 


© 




s 



2 


09 


O 













<X> 









a 


a 






S 


QQ 


uT 


• 


PL 






■-■- 






~_= 




■■■'"■ ' 


• ■ ■ ' 


Those in superior employments and 












' 


• 


their families. 


9 


2 


4 




15 


4 


11 


Physicians and their families. 


4 


1 


1 




6 


1 


5 


Instructers and Instructresses. 


5 


2 


1 




8 


3 


5 


Artists — painters — musicians. 


4 


5 


1 


1 


11 


2 


9 


Negociants. 


18 


9 


3 


1 


31 


9 


22 


Artisans — Masters. 


53 


32 


17 


14 


116 


28 


82 


„ Workmen. 


69 


34 


11 


6 


120 


37 


74 


„ Apprentices, 


3 








3 


1 


1 


Weavers. 


31 


16 


20 


9 


76 


25 


48 


Watermen 


29 


2 




1 


32 


3 


29 


Boatmen. 


19 








19 


2 


16 


Venders of wine, and Victuallers. 


6 


8 


2 




16 


5 


9 


Dealers in old clothes. 


3 


8 


1 




12 


. 3 


8 


Tailoresses, Seamstresses, and Laun- 
















dresses. 




11 






11 


5 


5 


Domestics. 


18 


32 


2 


1 


53 


17 


30 


Laborers. 


95 


39 


21 


12 


167 


30 


119 


Infirmary keepers, and Grave diggers. 


16 


9 






25 


14 


8 


Guards for the night. 


6 


1 




1 


8 


1 


5 


Widows and their families. 




75 


3 


6 


84 


19 


56 


Bachelors, and women separate. 




23 


4 


3 


30 


7 


19 


Pensioners. 


11 


18 






29 


11 


17 


Invalids. 


5 


4 


3 




12 


1 


10 


Public Women. 




6 






6 


1 


4 


Employments unknown. 


16 


27 


11 


10 


64 


14 


50 


Military men actively employed. 


10 




2 




12 


3 


8 


„ „ on furlough. 


3 


3 






6 


4 


2 


Total J 


452* 


373 


108) 


37 


1000 


263 


666 



3. The Jews have wonderfully escaped the cholera. At Po- 
ser), which contained 6,000 Jews when the cholera raged there, 
only 37 died of the disease. At Berlin, only six Jews had the 
disease during the two first months the cholera prevailed there. 
This exemption they undoubtedly owed to their accustomed so- 
briety, regularity and habitual prudence. 

4. It is curious to observe that more cases occur on certain days of 
the week than on others. Usually, the most cases occur on 
Tuesday, arid the least on Sunday. This probably arises from 
the excesses committed on Sunday. At Koenipsberg, the fol- 
lowing number of sick were attacked from the 23d of July to the 



360 APPENDIX 

28th of October, and the number of attacks for each day of the 
week is thus exhibited. 

Sunday ... 276 

Monday ... 282 

Tuesday - - . - 348 

Wednesday - 286 

Thursday - 295 

Friday 249 

Saturday ... 234 

Total, 1970. 

At Berlin, the cases for the first seven weeks of the prevalence 
of the cholera at that place, occurred on the following days : — 





Cases. 


Cured. 


Dead. 


Sundays 


195 


57 


148 


Mondays 


245 


60 


151 


Tuesdays 


272 


72 


153 


Wednesdays, 


260 


58 


142 


Thursdays 


252 


80 


184 


Fridays 


225 


63 


143 


Saturdays 


258 


55 


136 


Total, 


1,724 


454 


1,057 



5. At Berlin, several members of the same family were often 
affected, one after another, thus from August 29th to September 
26th, 770 cases were reported. During that period, a second case 
happened in the same house, 

After one day ... 65 times, 

two days ... 34 

three ... 23 

four .... 16 

five .... 21 

six .... 7 

seven - - - 3 

eight ... 2 

nine 

6. Other diseases were increased at Berlin, during the preva- 
lence of the cholera. The total number of deaths from the 3d to 
the 23d of September, 1830, was 436 : but for the same time in 
1831, was 552, exclusive of cholera cases. These 552 persons 
died of the following diseases: — Marasmus, 158 — Diarrhoea 
from dentition, 18 — Convulsions, 52 — Vomiting and Diarrhoea, 
12 — Apoplexy, 42 — Nervous Fever, 52 — Mucous Fever, 3 — Bil- 
ious Fever, 3 — Malignant Fever, 1 — Dropsy, 40 — Scarlatina, 
4 — Inflammation of the brain, 17 — Of the Lungs, 6 — Of the 
Bowels, 13 — Strangulated Hernia, 1 — Quinsy, 1 — Colic, 7 — 
Hemoptysis, 2 — Cancer of the Uterus, 3 — Palsy of the Lungs, 
11 — Scrofula, 9 — Vomiting Chronic, 1 — Disease of Heart, 4 — 



APPENDIX. 



361 



Of the Liver, 4— Of the Vertebra 1— Old Age, 52— Still-born, 
20 — iVbortion, 5 — Suicide, 1 — Deaths unknown, 6. 

7. In Prussia, the order of the victims of the cholera, was as 
follows : — 

1st. The aged men. 

2d. Drunkards. 

3d. The infirm, and valetudinarians. 

4th. The timid. 

The lower or poor class, furnished the greater part of the ca- 
ses that terminated fatally. The consumptive generally escaped 
the cholera at Berlin. 



Number of the cases of cholera that occurred in the Prussian 
States, previous to the 12th of November, 1831. 



Provinces. 


Cases. 


Deaths. 


Cured. 


Prussia, 


20563 


2231 


7418 


Posen, 


10542 


6037 


3631 


Silesia, 


2045 


1191 


594 


Brandenburg, 


4665 


2827 


1726 


Saxony, 


606 


360 


189 


Pomerania, 


1393 


847 


488 



The cities of Berlin, 
Kcenigsberg, Dantzic, Po- 
sen, Breslaw, Magdebourg 
and Stettin, have furnished 



39814 



23493 



14046 



8411 5269 2797 

[Gasete d'Etat de Prusse.] 



31 



362 



APPENDIX. 



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NOTE B. 

PROGRESS OP THE CHOLERA IN CANADA 
AND UNITED STATES. 

The first appearance of the epidemic cholera on this continent, 
was at Quebec and Montreal. At Quebec, the disease com- 
menced the 8th of June, and in a few days after, several cases of 
the same disease occurred at Montreal. 

The influx of emigrants into the Canadas, the present year, 
had been enormously great, and greater than any preceding 
year, as will appear from the following memorandum : 

The arrivals, tonnage and emigrants at the port of Quebec, 
made up from the Exchange Books to the 9th July : — 

Years. Vessels. Tonnage. Emigrants. 

99,961 6,528 

108,659 15,935 

130,051 32,327 

146,112 33,848 

From July 9th, to August 8th, 10,073 

Total in 1832, 43,921 

By some, the emigrants were supposed to have brought the 
disease, but as I have shown elsewhere, some cases of the same 
disease occurred before any arrival of emigrants from Europe; and 
it should be recollected that the lower town of Quebec, or that 
part of it, called the Cut de Sac, is, in the summer season, one of 
the most filthy places in the world. 

The following table will show the progress of the disease at 
Quebec, for the first two weeks of its prevalence there, though it 
includes only the Hospital cases. 

Quebec. — Cases of Cholera in the two hospitals, from 8 o'clock, 
A. M. on the 8th, to 8 o'clock, A. M. on the 21st inst. 



1829 


366 


1830 


421 


1831 


497 


1832 


544 



364 APPENDIX. 



1 


Remaining 
from last re- 
port. 


GO 

G 

.2 

J 

< 


> . 

o c 
<J o 


1 

PC -3 

Eg 2i 

Qg 


H3 


fcb 

"S 

"3 

S 
o 

05 


8th 


none 


3 


none 


none 


2 


1 


9th 


1 


13 


none 


none 


6 


8 


10th 


8 


10 


none 


none 


11 


7 


11th 


7 


13 


none 


none 


11 


9 


12th 


9 


27 


none 


none 


13 


23 


13th 


23 


77 


9 


none 


40 


60 


14th 


60 


48 


8 


none 


41 


67 


15th 


67 


68 


17 


2 


37 


96 


16th 


96 


98 


31 


3 


36 


155 


17th 


155 


47 


62 


5 


37 


160 


18th 


160 


46 


57 


2 


23 


181 


19th 


181 


66 


46 


12 


32 


199 


20th 


199 


60 


44 


20 


40 


100 


21st 


199 


37 


46 


6 


32 


198 



Total 609 507 

On the 7th day after the appearance of the cholera at Que- 
bec, 143 died of the disease; and on that and the succeeding five 
days, the deaths from cholera amounted to 711, being an average 
for the six days of 118 deaths per diem. From the commence- 
ment of the disease to the sixth of August, a period of fifty-eight 
days, the number of deaths from cholera at Quebec amounted to 
1790. — Neilsorfs Gazette, 

At Montreal, the disease raged with great violence, as will be 
seen from the following statement of the cases and deaths, from 
the commencement of the disease, to the 13th of July, inclusive : 





Daily cases. 


Daily burials. 


Total cases. 


Total deaths. 


June 10th to 15th, 




1328 


175 


June 16, 


381 


86 


1709 


261 


17, 


474 


102 


2183 


363 


18, 


261 


128 


2444 


491 


19, 


338 


149 


2781 


640 


20, 


165 


94 


2946 


734 


21, 


15 


76 


3097 


810 


22, 


109 


52 


3206 


862 


23, 


83 


31 


3289 


893 


24, 


51 


21 


3340 


914 


25, 


44 


33 


3384 


947 


26, 


27 


23 


3411 


976 


27, 


21 


25 


3432 


996 


28, 


22 


20 


3454 


1016 


29, 


37 


21 


3491 


1037 


30, 


32 


22 


3523 


1059 







APPENDIX. 




3 




Daily cases. 


Daily burials. 


Total cases. 


Total deaths 


July 1, 


23 


17 




3546 


1066 


2, 


13 


20 




3559 


1076 


3, 


11 


14 




3570 


1110 


4, 


23 


17 




3593 


1127 


5, 


22 


13 




3615 


1140 


6, 


19 


9 




3634 


1144 


7, 


13 


9 




3647 


1153 


8, 


14 


11 




3661 


1164 


9, 


10 


9 




3671 


1175 


10, 


7 


6 




3678 


1184 


11, 


14 


10 




3692 


1190 


12, 


15 


10 




3707 


1200 


13, 


9 


10 




3716 


1210 



Since the above statement was made, the disease has contin- 
ued .to prevail in Montreal. For a few days,, it seemed to cease, 
but then it broke out again with severity, and since the middle of 
July to the present time, Aug. 10, it has proved fatal to 10, 15 ? 
and 20 persons a day. 

The cholera commenced at New York about the 24th or 26th 
of June, The second day of July, the Board of Health announced 
that eleven cases had occurred, all of which had terminated fatal- 
ly, and that three new cases had that day been reported. The 
progress of the disease since then, has been as follows : 

P- H-J P- 1 hA 

^ K< o ^ k} © 

~a W a i?8 £ £o B ca B| £ 

t=i © < SL 

-t tn **» 

2 cT p- 
B * g 



4 
12 
15 
25 
21 
28 
44 
50 
51 
49 
66 
74 
94 
60 
72 
202 42 28 12 82 

226 48 42 10 100 

* These include all in the Bellevue Hospital from the 27th of 
June to the 7th of July, 
f These include all in Bellevue on the 9th and 9th, 



4th 


7 






5th 


15 


3 




6th 


11 


13 




7th 


42 


13 


30* 


8th 


29 


13 




9th 


18 


30 


57f 


10th 


44 


22 


43 


11th 


45 


31 


53 


12th 


32 


39 


48 


13th 


27 


39 


35 


14th 


43 


43 


29 


15th 


60 


53 


20 


16th 


92 


50 


21 


17th 


60 


63 


23 


18th 


65 


59 


14 


19th 


114 


77 


11 


20th 132 


66 


28 



So 


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7 


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18 


10 


2 






24 


8 


7 






85 


6 


6 


13* 




42 


10 


11 






105 


4 


10 


14f 




109 


6 


13 


25 




129 


10 


15 


25 




119 


10 


16 


25 




101 


10 


22 


17 




115 


15 


29 


22 




133 


28 


31 


15 




163 


45 


32 


17 




146 


19 


29 


12 




138 


22 


36 


14 



366 








APPENDIX. 












Cu 








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CD 






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21st 


191 


100 


20 




3ii 


'61 


33 


10 




104 


22d 


154 


76 


9 


2 


241 


50 


35 


5 


1 


91 


23d 


163 


42 


26 




231 


46 


17 


20 




83 


24th 188 


51 


22 


35§ 


296 


57 


22 


7 


10§ 


96 


25th 


99 


45 


10 


3t 


157 


21 


32 


5 


3t 


61 


26th 


75 


48 


14 


4 


141 


23 


21 


7 


4 


55 


27th 


73 


46 


3 


IT 


122 


23 


18 


5 


IT 


46 


28th 


93 


49 


1 


2 


145 


37 


26 


4 


HI 


68 


29th 


61 


58 


1 


2 


122 


19 


15 


3 


3 


39 


30th 


62 


35 


3 


3 


103 


14 


19 


3 


3 


39 


31st 


59 


52 


1 


9 


121 


23 


20 


3 


2 


48 


Aug. 1,47 


33 


4 


2 


92 


13 


21 


3 


1 


41 


2d 


47 


24 





10 


8i 


14 


17 





3 


34 


3d 


48 


36 


1 


5 


90 


14 


8 


1 


1 


24 


4th 


48 


35 


3 


2 


88 


17 


11 


2 





30 


5th 


57 


38 





1 


96 


21 


8 








29 


6th 


60 


38 





3 


101 


21 


15 





1 


37 


7th 


57 


31 





1 


89 


19 


12 





1 


32 


8th 


50 


32 








82 


12 


9 








21 


9th 


47 


26 








73 


18 


10 








28 


10th 


60 


34 





3 


97 


18 


7 





1 


26 


11th 


33 


41 





2 


76 


18 


15 








33 


12th 


32 


33 





2 


67 


9 


12 





2 


23 


13th 


63 


41 





1 


104 


16 


6 





1 


22 


14th 


18 


24 







42 


8 


7 







15 


15th 


33 


29 


13 




75 


14 


9 


4 




26 


16th 


39 


37 


3 




79 


14 


11 


1 




26 


17th 


28 


25 


10 




43 


14 


8 


2 




21 


18th 


38 


38 


1 




76 


6 


13 







19 



Tot. 2859 1817 556 92 5323 937 789 305 38 2057 
It is worthy of notice, that during the prevalence of the cholera 
at New York, the number of deaths from other diseases has been 
greater than usual, notwithstanding the number of inhabitants 
has greatly diminished ; the same was observed at Berlin. 
The whole number of deaths in the month of 
July, 1830, was 664. 
" 1831, 512. 
Exclusive of cholera cases, " 1832, 751. 

The deaths and diseases for the three weeks that the cholera 
was most fatal at New York, were as follows, from July 7th to 
the 28th : — Abscess, 1 ; Apoplexy, 9 ; Asphyxia, 2 ; Burns, 1 
Casualty, 7 ; Cholera, malignant, 1741 ; Cholera Morbus, 34 
Child-bed, 2 ; Colic, 1 ; Consumption, 83 ; Convulsions, 38 



X Haerlem not heard from. § Including two days. 1T Not heard from. 



APPENDIX. 367 

Cramp in the stomach, 5; Drinking cold water, 1; Diarrhoea, 
13; Dropsy in head, 22; Drowned, 5; Dysentery, 9; Epilepsy, 
7; Fever, 4; Bilious fever, 3 ; Remittent, 3; Scarlet, 6; Typhus, 
5; Flux infa utile, 44; Hemorrhage, 1 ; Hemoptysis, 1 ; Croup, 8 ; 
Inflammation of bowels, 20; Inflammation of brain, 13; Inflam- 
mation of chest, 5; Inflammation of liver, 1; Inflammation of 
stomach, 2 : Intemperance, 9 ; Locked Jaw, 2 ; Marasmus, 24 ; 
Measles, 18 ; Mortification, 3 ; Old age, 17 ; Palsy, 3 ; Peripneu- 
mony, 7; Rheumatism, 1 ; Smallpox, 2; Stillborn, 25 ; Schir- 
rus, 2 ; Sore throat, 2 ; Spinabifida, 1 ; Tabes Mesenterica, 4 ; 
Teething, 7 ; Unknown, 20 ; Whooping cough, 6 ; Worms, 7. 

The disease appeared at Albany, July 3d, and since then, cases 
have occurred daily. From the commencement of the disease to 
the present time, August 18th, 1131 cases have occurred at Alba- 
ny, of which 319 have terminated fatally. The disease appears 
now to be on the decline in that city. 

A few cases of cholera occurred at Philadelphia, about the mid- 
dle of July, but the disease soon subsided, until the 27th, when it 
again appeared, and has thus continued. 

Number of persons attacked with the Spasmodic cholera, and 
the deaths by that disease which have taken place in Philadel- 
phia and Liberties, from the 27th of July to the present time. 







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142 


39 


j* 


11 


76 


42 


8 





126 


33 


j> 


12 


66 


39 








110 


31 


>» 


13 










130 


49 


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14 










111 


37 


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15 










73 


23 


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16 










94 


30 


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17 










90 
1610 


26 
615 



368 APPENDIX 

The 5th of July, the cholera appeared at Detroit, where it 
prevailed for some time. The 17th of July, at Buffalo, and boon 
after, the disease prevailed in several towns on the banks of the 
Grand canal in the state of New York. 

It appeared in several towns in New Jersey, about the middle 
of July, and the 24th of the same month it broke out at Norfolk 
and Portsmouth in Virginia, where it still continues to rage with 
great violence, especially among the colored population. 

Several towns in Connecticut were slightly visited by the dis- 
ease in the course of July. 

It appeared in Rhode Island about the first of August; and the 
15th of the same month, two cases occurred in Boston, and about 
the same time it commenced at Baltimore, and within a few days, 
several cases have occurred at Elizabeth city, North Carolina. 

Since the first of July, more \h%x\ fifty towns have been visited 
by the Epidemic or Malignant cholera, and the disease appears 
still to be extending in every direction. Among the towns which 
have already been visited by the disease, are Newark, Princeton, 
Trenton, New Brunswick, Elizabethtown, &c, &c. N. Jersey ; 
Cleaveland and other towns in Ohio ; New T Haven, Hartford, 
New London, &c. Connecticut ; Troy, Lansingburg, Rochester, 
Utica, Syracuse, Poughkeepsie, Lockport, Brooklyn, Schenecta- 
dy, &c. &c. state of New York ; Wilmington and Newcastle in 
Delaware. It has already appeared in 12 of the U. states, and 
from the past progress of the disease, we have no reason to hope 
that any state in the Union will be exempted from a visitation of 
the epidemic, though we trust it will be, in general, far less violent 
and fatal in the interior of the country, and in the small towns, 
than it has been in the large cities where it has already prevailed. 
Our expectation of a diminution hereafter in the violence of the 
disease, is founded upon the belief that other places will profit by 
the sad experience of the towns where it has already prevailed, 
and by attention to cleanliness, the purification of houses, the di- 
minution of the inmates in small and crowded dwellings, the 
clothing and feeding of the poor, and above all, by a general 
abandonment of vicious, sensual, and intemperate habits, either 
stay the progress of the evil, or greatly lessen its ravages. 

This universal and mortal epidemic has long called loudly 
Upon mankind for a reformation in these respects ; it has spoken 
to them by the voices of millions of their dying fellow creatures, 
to live temperately and soberly, and to provide for the sufferir g 
poor, before the disease comes upon them. When, therefore, 
mankind give attention to the past and present admonitions, and 
hearken to the voice of reason, and not to that of passion or appe- 
tite, then may we confidently expect the disease, which is now 
sweeping over our country with frightful mortality, will be 8Q- 
tirely arrested, or its violence greatly mitigated. 

Hartford, Adg, 20th, 1832. 



3477 



